Provider Demographics
NPI:1063734911
Name:CHANDRAHASAN, PRABHATHKUMAR C (RPH, PHARMD)
Entity type:Individual
Prefix:MR
First Name:PRABHATHKUMAR
Middle Name:C
Last Name:CHANDRAHASAN
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 CENTENNIAL AVE
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-4324
Mailing Address - Country:US
Mailing Address - Phone:732-981-1926
Mailing Address - Fax:732-981-8942
Practice Address - Street 1:1306 CENTENNIAL AVE
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-4324
Practice Address - Country:US
Practice Address - Phone:732-981-1926
Practice Address - Fax:732-981-8942
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03040300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist