Provider Demographics
NPI:1255630901
Name:CHERIAN, ACHAMMA (RPH)
Entity type:Individual
Prefix:
First Name:ACHAMMA
Middle Name:
Last Name:CHERIAN
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 1:15 GLENCOE DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-2061
Mailing Address - Country:US
Mailing Address - Phone:302-453-7451
Mailing Address - Fax:
Practice Address - Street 1:1602 KIRKWOOD HIGHWAY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711
Practice Address - Country:US
Practice Address - Phone:302-453-1337
Practice Address - Fax:302-368-6702
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0002743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist