Provider Demographics
NPI:1740575448
Name:CHEWJALEARN, CHONLADA
Entity Type:Individual
Prefix:
First Name:CHONLADA
Middle Name:
Last Name:CHEWJALEARN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 S RAINBOW BLVD
Mailing Address - Street 2:T-0850
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-1004
Mailing Address - Country:US
Mailing Address - Phone:702-252-4600
Mailing Address - Fax:702-525-4600
Practice Address - Street 1:3550 S RAINBOW BLVD
Practice Address - Street 2:T-0850
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-1004
Practice Address - Country:US
Practice Address - Phone:702-252-4600
Practice Address - Fax:702-252-4600
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist