Provider Demographics
NPI:1861049744
Name:PRAJAPATI, CHETNABEN A (RPH)
Entity type:Individual
Prefix:
First Name:CHETNABEN
Middle Name:A
Last Name:PRAJAPATI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29876 CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-4535
Mailing Address - Country:US
Mailing Address - Phone:714-606-9742
Mailing Address - Fax:
Practice Address - Street 1:3960 BROAD ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7018
Practice Address - Country:US
Practice Address - Phone:805-783-2903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-24
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77740183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist