Provider Demographics
NPI:1568637015
Name:SANDHU, MANEESH K (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MANEESH
Middle Name:K
Last Name:SANDHU
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 1:12846 DEER PARK LN
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-7425
Mailing Address - Country:US
Mailing Address - Phone:770-667-5478
Mailing Address - Fax:
Practice Address - Street 1:2090 DUNWOODY CLUB DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-5434
Practice Address - Country:US
Practice Address - Phone:770-391-9792
Practice Address - Fax:770-391-0989
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH023457OtherSTATE OF GEORGIA PHARMACY BOARD