Provider Demographics
NPI:1407254600
Name:DALSANIA, SVETA MANU
Entity Type:Individual
Prefix:
First Name:SVETA
Middle Name:MANU
Last Name:DALSANIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26211 THORNRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-9281
Mailing Address - Country:US
Mailing Address - Phone:703-554-2313
Mailing Address - Fax:
Practice Address - Street 1:100 E VIENNA ST
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-1421
Practice Address - Country:US
Practice Address - Phone:810-687-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-21
Last Update Date:2014-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039439183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist