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General NPI Number Information
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NPI Number | 1447743109
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Entity Type | Individual
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Provider Name | SANJAY SURESHCHANDRA JAIN
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Gender | Male
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Dates
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Enumeration Date | 06/07/2018
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Last Update Date | 06/07/2018
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Provider Practice Location Address
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Address Line | 11801 N SAGINAW ST
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City | MOUNT MORRIS
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State | MI
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Zip | 48458-1503
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Country | US
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Telephone | 810-686-7106
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Fax |
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Provider Business Mailing Address
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Address Line | 2019 FOX HILL DR APT 6
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City | GRAND BLANC
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State | MI
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Zip | 48439-5206
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Country | US
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Telephone | 248-773-6236
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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 | 5302040189
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License Number State | MI
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