Provider Demographics
NPI:1285851733
Name:PATHAK, VANDANKUMAR JAGADISHCHANDRA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VANDANKUMAR
Middle Name:JAGADISHCHANDRA
Last Name:PATHAK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3816 SUNSCAPE DR
Mailing Address - Street 2:APT# 408
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3175
Mailing Address - Country:US
Mailing Address - Phone:540-989-0518
Mailing Address - Fax:
Practice Address - Street 1:1900 ELECTRIC RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7474
Practice Address - Country:US
Practice Address - Phone:540-776-4130
Practice Address - Fax:540-776-4982
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205879183500000X
MD16156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist