Provider Demographics
NPI:1316267941
Name:CHANDIRAMANI, BHAGWAN (RPH)
Entity type:Individual
Prefix:MR
First Name:BHAGWAN
Middle Name:
Last Name:CHANDIRAMANI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-1135
Mailing Address - Country:US
Mailing Address - Phone:516-742-2340
Mailing Address - Fax:
Practice Address - Street 1:1515 HAZEN ST
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1395
Practice Address - Country:US
Practice Address - Phone:718-546-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-05
Last Update Date:2010-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist