Provider Demographics
NPI:1962093484
Name:CHAVARRIA, GILBERT (RPH)
Entity type:Individual
Prefix:MR
First Name:GILBERT
Middle Name:
Last Name:CHAVARRIA
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 1:6361 EASTERN RANGE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-5026
Mailing Address - Country:US
Mailing Address - Phone:317-201-8895
Mailing Address - Fax:
Practice Address - Street 1:7506 N SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2066
Practice Address - Country:US
Practice Address - Phone:317-595-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019304A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist