Provider Demographics
NPI:1639709520
Name:GANDHI, RAVI (PHARMD)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:
Last Name:GANDHI
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 1:3833 HYACINTH DR
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-9806
Mailing Address - Country:US
Mailing Address - Phone:209-602-1118
Mailing Address - Fax:
Practice Address - Street 1:12648 BENTLEY ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CA
Practice Address - Zip Code:95386-9009
Practice Address - Country:US
Practice Address - Phone:209-874-8185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-20
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist