Provider Demographics
NPI:1003475807
Name:RANDHAWA, HARDIP (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HARDIP
Middle Name:
Last Name:RANDHAWA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 STANDIFORD AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0180
Mailing Address - Country:US
Mailing Address - Phone:209-574-6299
Mailing Address - Fax:
Practice Address - Street 1:3021 STANFORD RANCH RD
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5537
Practice Address - Country:US
Practice Address - Phone:916-435-2882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA68193OtherBOARD OF PHARMACY REGISTERED PHARMACIST LICENSE NO.