Healthcare Provider Details

I. General information

NPI: 1720137680
Provider Name (Legal Business Name): SANDEEP P ANANTANI RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 E MAIN ST
SANTA MARIA CA
93454-4809
US

IV. Provider business mailing address

1430 E MAIN ST
SANTA MARIA CA
93454-4809
US

V. Phone/Fax

Practice location:
  • Phone: 805-922-1979
  • Fax: 805-928-0713
Mailing address:
  • Phone: 805-922-1979
  • Fax: 805-928-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number45739
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number45739
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number45739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: