Provider Demographics
NPI:1740682244
Name:CHUDAWALA, AMI
Entity type:Individual
Prefix:
First Name:AMI
Middle Name:
Last Name:CHUDAWALA
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 1:891 CHANDELIER CT
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2811
Mailing Address - Country:US
Mailing Address - Phone:626-271-2350
Mailing Address - Fax:
Practice Address - Street 1:2005 TOWN CENTER PLZ
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-4957
Practice Address - Country:US
Practice Address - Phone:916-384-0978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70877183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist