Provider Demographics
NPI:1548856727
Name:CHAVIANO, PABLO EDEL (PHARMD)
Entity type:Individual
Prefix:
First Name:PABLO
Middle Name:EDEL
Last Name:CHAVIANO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 AVENUE A APT 4
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-1853
Mailing Address - Country:US
Mailing Address - Phone:201-286-0378
Mailing Address - Fax:
Practice Address - Street 1:900 MADISON ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6483
Practice Address - Country:US
Practice Address - Phone:201-792-9652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03883800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist