Healthcare Provider Details

I. General information

NPI: 1912397381
Provider Name (Legal Business Name): AJAYDIP SAHOTA PHARM S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 11/26/2021
Certification Date: 11/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 LENNON LN
WALNUT CREEK CA
94598-2414
US

IV. Provider business mailing address

501 LENNON LN
WALNUT CREEK CA
94598-2414
US

V. Phone/Fax

Practice location:
  • Phone: 925-412-4097
  • Fax:
Mailing address:
  • Phone: 925-412-4097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number3131744
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number64884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: