Healthcare Provider Details

I. General information

NPI: 1700939881
Provider Name (Legal Business Name): JASON LEE BANDY PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST SUITE 0400 - INTERNAL MEDICINE - ANTICOAG CLINIC
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

6321 VILAMOURA WAY
ELK GROVE CA
95757-3415
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-1482
  • Fax: 916-734-7402
Mailing address:
  • Phone: 916-734-1482
  • Fax: 916-734-7402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number52511
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: