Provider Demographics
NPI:1275855991
Name:PANDE, RAJ (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAJ
Middle Name:
Last Name:PANDE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 MEADOW DR
Mailing Address - Street 2:APT #4
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2821
Mailing Address - Country:US
Mailing Address - Phone:832-797-6583
Mailing Address - Fax:
Practice Address - Street 1:1066 PAYNE AVE
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-2720
Practice Address - Country:US
Practice Address - Phone:716-694-0323
Practice Address - Fax:716-693-1506
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053280-1183500000X
TX29711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist