Provider Demographics
NPI:1427277920
Name:MAIY, CHANTRA (CPHT)
Entity type:Individual
Prefix:
First Name:CHANTRA
Middle Name:
Last Name:MAIY
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:CHANTRA
Other - Middle Name:
Other - Last Name:TAING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPHT
Mailing Address - Street 1:18 ACORN ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-3825
Mailing Address - Country:US
Mailing Address - Phone:781-367-4072
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3125183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician