Provider Demographics
NPI:1710552773
Name:PANCHUMARTHI, CHANDRA SEKHAR
Entity Type:Individual
Prefix:
First Name:CHANDRA SEKHAR
Middle Name:
Last Name:PANCHUMARTHI
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 1:7072 N CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3300
Mailing Address - Country:US
Mailing Address - Phone:559-321-8608
Mailing Address - Fax:559-472-3103
Practice Address - Street 1:7072 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3300
Practice Address - Country:US
Practice Address - Phone:559-321-8608
Practice Address - Fax:559-472-3103
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-22
Last Update Date:2021-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65850183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist