Individual
CHANTRA PROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
7940 PENN AVE S, BLOOMINGTON, MN 55431-1315
(952) 252-1154
(952) 252-1157
Mailing address
7940 PENN AVE S, BLOOMINGTON, MN 55431-1315
(952) 252-1154
(952) 252-1157
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
121468
MN
Other
Enumeration date
02/25/2015
Last updated
02/25/2015
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