MEDICARE: SANTOSH N PANDYA PHARMACIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302036078	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710492673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANTOSH N PANDYA PHARMACIST

Provider Business Mailing Address
First Line	:	6300 COMMERCE DR
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48185-9120
Country	:	US
Telephone Number	:	734-728-4030
Fax Number	:	734-728-4037

Provider Business Practice Location Address
First Line	:	16311 GRAND RIVER AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48227-1825
Country	:	US
Telephone Number	:	313-838-1100
Fax Number	:	313-838-1103

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2017
Last Update Date	:	01/14/2021

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Directions to “ SANTOSH N PANDYA PHARMACIST” Practice Location

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