Healthcare Provider Details

I. General information

NPI: 1164370243
Provider Name (Legal Business Name): SANDI KASHAT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56805 VAN DYKE AVE
SHELBY TOWNSHIP MI
48316-5894
US

IV. Provider business mailing address

56805 VAN DYKE AVE
SHELBY TOWNSHIP MI
48316-5894
US

V. Phone/Fax

Practice location:
  • Phone: 586-786-1856
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302415276
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: