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General NPI Number Information
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NPI Number | 1710492673
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Entity Type | Individual
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Provider Name | SANTOSH N PANDYA PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 12/13/2017
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Last Update Date | 01/14/2021
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Provider Practice Location Address
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Address Line | 16311 GRAND RIVER AVE
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City | DETROIT
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State | MI
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Zip | 48227-1825
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Country | US
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Telephone | 313-838-1100
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Fax | 313-838-1103
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Provider Business Mailing Address
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Address Line | 6300 COMMERCE DR
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City | WESTLAND
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State | MI
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Zip | 48185-9120
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Country | US
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Telephone | 734-728-4030
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Fax | 734-728-4037
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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 | 5302036078
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License Number State | MI
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