Provider Demographics
NPI:1790364388
Name:CHANDRA, ANNUPMA (RPH)
Entity Type:Individual
Prefix:
First Name:ANNUPMA
Middle Name:
Last Name:CHANDRA
Suffix:
Gender:F
Credentials:RPH
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 632
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:CT
Mailing Address - Zip Code:06757-0632
Mailing Address - Country:US
Mailing Address - Phone:860-927-3725
Mailing Address - Fax:
Practice Address - Street 1:38 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:CT
Practice Address - Zip Code:06757-1511
Practice Address - Country:US
Practice Address - Phone:860-927-3725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8304183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist