Provider Demographics
NPI:1588761621
Name:CHIAT, RANDOLPH S (BS)
Entity type:Individual
Prefix:MR
First Name:RANDOLPH
Middle Name:S
Last Name:CHIAT
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 BEECHAM CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-6001
Mailing Address - Country:US
Mailing Address - Phone:410-902-6788
Mailing Address - Fax:
Practice Address - Street 1:216 MOUNT CARMEL RD
Practice Address - Street 2:
Practice Address - City:PARKTON
Practice Address - State:MD
Practice Address - Zip Code:21120-9725
Practice Address - Country:US
Practice Address - Phone:410-357-4211
Practice Address - Fax:410-357-8002
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist