Provider Demographics
NPI:1649435520
Name:CHANTRA, MICHELE (PHARM D)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:CHANTRA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 PENFIELD RD
Mailing Address - Street 2:ATTN: PHARMACY MANAGER
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1742
Mailing Address - Country:US
Mailing Address - Phone:585-248-3060
Mailing Address - Fax:585-377-9612
Practice Address - Street 1:2155 PENFIELD RD
Practice Address - Street 2:ATTN: PHARMACY MANAGER
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1742
Practice Address - Country:US
Practice Address - Phone:585-248-3060
Practice Address - Fax:585-377-9612
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049799183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY049799OtherPHARMACIST LICENSE