Provider Demographics
NPI:1952687311
Name:SOMPURA, CHIRAG (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:CHIRAG
Middle Name:
Last Name:SOMPURA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19222 NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-2271
Mailing Address - Country:US
Mailing Address - Phone:201-736-4154
Mailing Address - Fax:
Practice Address - Street 1:19800 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-1234
Practice Address - Country:US
Practice Address - Phone:313-273-9219
Practice Address - Fax:423-468-3180
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35548183500000X
MI5302039856183500000X
TX56348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN35548OtherPHARMACIST
MI5302039856OtherPHARMACIST
TX56348OtherPHARMACIST