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General NPI Number Information
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NPI Number | 1295518017
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Entity Type | Individual
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Provider Name | VIJAY MANI SATHAPPAN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/15/2023
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 5875 E FRANKLIN RD
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City | NAMPA
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State | ID
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Zip | 83687-5450
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Country | US
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Telephone | 208-461-8718
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Fax |
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Provider Business Mailing Address
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Address Line | 1070 SHADY CHARMER AVE
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City | HENDERSON
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State | NV
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Zip | 89052-8690
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Country | US
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Telephone | 702-882-8294
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | P10772
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License Number State | ID
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