Provider Demographics
NPI:1225369853
Name:PANDYA, KEYURA B (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KEYURA
Middle Name:B
Last Name:PANDYA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 W BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-3000
Mailing Address - Country:US
Mailing Address - Phone:602-283-1603
Mailing Address - Fax:
Practice Address - Street 1:5115 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-3000
Practice Address - Country:US
Practice Address - Phone:602-283-1603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15121183500000X
NJRI02333800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist