Provider Demographics
NPI:1194096537
Name:DAVE, SIRISH CHANDRA (PHD)
Entity type:Individual
Prefix:
First Name:SIRISH
Middle Name:CHANDRA
Last Name:DAVE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 EINSTEIN WAY
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08512-2540
Mailing Address - Country:US
Mailing Address - Phone:609-443-4052
Mailing Address - Fax:
Practice Address - Street 1:30 EINSTEIN WAY
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08512-2540
Practice Address - Country:US
Practice Address - Phone:609-443-4052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.032654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist