Provider Demographics
NPI:1487329397
Name:MARTIN, CHANDLER MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHANDLER
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 TUCKAHOE RD APT 1D
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-5219
Mailing Address - Country:US
Mailing Address - Phone:914-708-9310
Mailing Address - Fax:
Practice Address - Street 1:623 MCLEAN AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-4734
Practice Address - Country:US
Practice Address - Phone:914-965-6100
Practice Address - Fax:914-965-6948
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI067969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist