Provider Demographics
NPI:1831506427
Name:CHENNAT, JUDY BEN (PHARM D)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:BEN
Last Name:CHENNAT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 TWIN ARCH RD
Mailing Address - Street 2:SUITE#18
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-4138
Mailing Address - Country:US
Mailing Address - Phone:301-829-0966
Mailing Address - Fax:310-829-5213
Practice Address - Street 1:1001 TWIN ARCH RD
Practice Address - Street 2:SUITE#18
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-4138
Practice Address - Country:US
Practice Address - Phone:301-829-0966
Practice Address - Fax:310-829-5213
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist