Provider Demographics
NPI:1184141426
Name:CHILBERT, MAYA RACHAEL (PHARMD, BCCP)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:RACHAEL
Last Name:CHILBERT
Suffix:
Gender:F
Credentials:PHARMD, BCCP
Other - Prefix:
Other - First Name:MAYA
Other - Middle Name:RACHAEL
Other - Last Name:HOLSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:202 PHARMACY BUILDING
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-3827
Mailing Address - Country:US
Mailing Address - Phone:716-829-5172
Mailing Address - Fax:
Practice Address - Street 1:100 HIGH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1126
Practice Address - Country:US
Practice Address - Phone:716-829-5172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03236987183500000X
NY0654501835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist