MEDICARE: MR. SANJAY RAZDAN RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS27750	FL
2	183500000X	Pharmacist	RPH017876	GA

General Provider Information

NPI Number	:	1699217893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SANJAY RAZDAN RPH

Provider Business Mailing Address
First Line	:	3635 E PACES CIR NE
Second Line	:	UNIT 1414
City	:	ATLANTA
State	:	GA
Zip	:	30326-7811
Country	:	US
Telephone Number	:	404-395-1771
Fax Number	:

Provider Business Practice Location Address
First Line	:	3635 E PACES CIR NE
Second Line	:	UNIT 1414
City	:	ATLANTA
State	:	GA
Zip	:	30326-7811
Country	:	US
Telephone Number	:	678-316-0957
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2016
Last Update Date	:	05/27/2020

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