Provider Demographics
NPI:1710268016
Name:CHATTERJEE, SRIDEEP (RPH)
Entity Type:Individual
Prefix:MR
First Name:SRIDEEP
Middle Name:
Last Name:CHATTERJEE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1352 BALLENA BLVD APT 304
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-3620
Mailing Address - Country:US
Mailing Address - Phone:510-903-2309
Mailing Address - Fax:510-903-2309
Practice Address - Street 1:8102 E 14 TH STREET
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621
Practice Address - Country:US
Practice Address - Phone:510-633-3044
Practice Address - Fax:510-633-1042
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65310183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist