Provider Demographics
NPI:1053753087
Name:VIPPARLA, CHANDRA S (RPH)
Entity type:Individual
Prefix:
First Name:CHANDRA
Middle Name:S
Last Name:VIPPARLA
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 1:615 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-2112
Mailing Address - Country:US
Mailing Address - Phone:203-785-9001
Mailing Address - Fax:203-562-4448
Practice Address - Street 1:615 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-2112
Practice Address - Country:US
Practice Address - Phone:203-785-9001
Practice Address - Fax:203-562-4448
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist