Mitesh B Champaneria, PHARMACIST

Primary specialty

PharmacistTaxonomy code 183500000X

License

0000040457 Issued in TN

Practice address

2975 Fort Campbell Blvd
Clarksville, TN 37042-3021

Phone

(931) 431-4977

Fax

(931) 431-0235

NPI assigned

Sep 4, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Walgreen Co

  • Pharmacy
  • Clarksville, TN
  • NPI 1760797088
  NPD
• Walgreen Co

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1467066571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2975 FORT CAMPBELL BLVD",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370423021",
            "telephone_number": "931-431-4977",
            "fax_number": "931-431-0235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2975 FORT CAMPBELL BLVD",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370423021",
            "telephone_number": "931-431-4977",
            "fax_number": "931-431-0235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMPANERIA",
        "first_name": "MITESH",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "PHARMACIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-04",
        "last_updated": "2023-11-27",
        "certification_date": "2020-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TN",
            "license": "0000040457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Mirixa",
            "affiliation": "Y",
            "endpointDescription": "Outcomes",
            "affiliationName": "WALGREEN CO",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Print copy",
            "address_1": "2975 Fort Campbell Blvd",
            "city": "Clarksville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "370423021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Victoria Lindsay Chaffin
• Brian C Chalker, CRNA
• Lauren Challoner
• Carolyn Beth Chambers, RPH
• Veronica Laverne Chambers, B.S
• Dajanae Chandler
• Gavic Jaacob Chandler, M.A.
• Kimberly Diane Chandler, BSW
• Changing Lives Incorporation
• Alexis Chapman

• Pharmacist in Clarksville, TN
• Providers in Clarksville, TN by specialty
• Pharmacist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.