Provider Demographics
NPI:1710224720
Name:CHIDAMBARAM, SETHURAMAN
Entity Type:Individual
Prefix:MR
First Name:SETHURAMAN
Middle Name:
Last Name:CHIDAMBARAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-3640
Mailing Address - Country:US
Mailing Address - Phone:615-849-6259
Mailing Address - Fax:615-849-6264
Practice Address - Street 1:3415 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3640
Practice Address - Country:US
Practice Address - Phone:615-849-6259
Practice Address - Fax:615-849-6264
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29499183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN29499OtherPHARMACIST LICENSE NUMBER