Provider Demographics
NPI:1992316970
Name:KETHDY, CHINTHIDA NORA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHINTHIDA
Middle Name:NORA
Last Name:KETHDY
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 1:2720 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4635
Mailing Address - Country:US
Mailing Address - Phone:765-287-8533
Mailing Address - Fax:765-287-8543
Practice Address - Street 1:2720 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-4635
Practice Address - Country:US
Practice Address - Phone:765-287-8533
Practice Address - Fax:765-287-8543
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028521A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist