Provider Demographics
NPI:1659974236
Name:JIVAN, SONAL (PHARM D)
Entity Type:Individual
Prefix:
First Name:SONAL
Middle Name:
Last Name:JIVAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 PEACHTREE PKWY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6818
Mailing Address - Country:US
Mailing Address - Phone:770-889-1301
Mailing Address - Fax:770-889-5114
Practice Address - Street 1:450 PEACHTREE PKWY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6818
Practice Address - Country:US
Practice Address - Phone:770-889-1301
Practice Address - Fax:770-889-5114
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1083879571OtherNPI