Provider Demographics
NPI:1740730175
Name:CHOWDARY, DIVYA
Entity type:Individual
Prefix:
First Name:DIVYA
Middle Name:
Last Name:CHOWDARY
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 1:1216 E NORTHRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-2969
Mailing Address - Country:US
Mailing Address - Phone:626-975-4977
Mailing Address - Fax:
Practice Address - Street 1:1216 E NORTHRIDGE AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-2969
Practice Address - Country:US
Practice Address - Phone:626-975-4977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist