Provider Demographics
NPI:1265984355
Name:CHHATRALA, SIMAKUMARI
Entity type:Individual
Prefix:
First Name:SIMAKUMARI
Middle Name:
Last Name:CHHATRALA
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 1:1801 WINDSOR SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-4662
Mailing Address - Country:US
Mailing Address - Phone:704-847-0118
Mailing Address - Fax:704-847-0286
Practice Address - Street 1:1801 WINDSOR SQUARE DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4662
Practice Address - Country:US
Practice Address - Phone:704-847-0118
Practice Address - Fax:704-847-0286
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist