=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952639544
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAJ MITAN GANDHI PHARM.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2009
-----------------------------------------------------
Last Update Date | 11/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7751 S MANTHEY RD
-----------------------------------------------------
City | FRENCH CAMP
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95231-9802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-497-1400
-----------------------------------------------------
Fax | 209-461-2537
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16500 RUSTLING OAK CT
-----------------------------------------------------
City | MORGAN HILL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95037-6724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 63336
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------