Provider Demographics
NPI:1760780381
Name:KRISHNASAMY, CHANDRAVEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRAVEL
Middle Name:
Last Name:KRISHNASAMY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 WILLIAMSBURG RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-2033
Mailing Address - Country:US
Mailing Address - Phone:804-222-2705
Mailing Address - Fax:804-222-0854
Practice Address - Street 1:2708 WILLIAMSBURG RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-2033
Practice Address - Country:US
Practice Address - Phone:804-222-2705
Practice Address - Fax:804-222-0854
Is Sole Proprietor?:No
Enumeration Date:2011-03-06
Last Update Date:2011-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist