Provider Demographics
NPI:1801567896
Name:CHAMPANERI, KAJOL BEN (PHARMD)
Entity type:Individual
Prefix:
First Name:KAJOL BEN
Middle Name:
Last Name:CHAMPANERI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 W BEACON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-3203
Mailing Address - Country:US
Mailing Address - Phone:601-389-1119
Mailing Address - Fax:
Practice Address - Street 1:1005 W BEACON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-3203
Practice Address - Country:US
Practice Address - Phone:601-389-1119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE100404183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist