Provider Demographics
NPI:1558184184
Name:VATTIKONDA, CHANDRA S (RPH)
Entity type:Individual
Prefix:MR
First Name:CHANDRA
Middle Name:S
Last Name:VATTIKONDA
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 1:2807 TWIN EAGLES DR
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-4699
Mailing Address - Country:US
Mailing Address - Phone:973-723-4523
Mailing Address - Fax:
Practice Address - Street 1:2409 ALCO AVE STE C
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-2614
Practice Address - Country:US
Practice Address - Phone:214-919-2399
Practice Address - Fax:214-919-2344
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist