Provider Demographics
NPI:1366924771
Name:TCHERNAIA, EDWARD (PHARMD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:TCHERNAIA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-4614
Mailing Address - Country:US
Mailing Address - Phone:617-894-4612
Mailing Address - Fax:
Practice Address - Street 1:11 NEWBURY ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1014
Practice Address - Country:US
Practice Address - Phone:978-750-4334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH236444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist