Provider Demographics
NPI:1710598636
Name:RATH, CHETRA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHETRA
Middle Name:
Last Name:RATH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1213
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01853-1213
Mailing Address - Country:US
Mailing Address - Phone:978-995-2128
Mailing Address - Fax:
Practice Address - Street 1:276 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-4121
Practice Address - Country:US
Practice Address - Phone:978-458-8441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH239636183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPH239636OtherPHARMACIST LICENSE NUMBER