Provider Demographics
NPI:1962725093
Name:JAIN, CHETAK (PHARMD)
Entity type:Individual
Prefix:
First Name:CHETAK
Middle Name:
Last Name:JAIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BONNIE LYNN CT
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3040
Mailing Address - Country:US
Mailing Address - Phone:516-902-4468
Mailing Address - Fax:
Practice Address - Street 1:10 BONNIE LYNN CT
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-3040
Practice Address - Country:US
Practice Address - Phone:516-902-4468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048516183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist