Provider Demographics
NPI:1699217893
Name:RAZDAN, SANJAY (RPH)
Entity Type:Individual
Prefix:MR
First Name:SANJAY
Middle Name:
Last Name:RAZDAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:SANJAY
Other - Middle Name:
Other - Last Name:RAZDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:3635 E PACES CIR NE
Mailing Address - Street 2:UNIT 1414
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-7811
Mailing Address - Country:US
Mailing Address - Phone:404-395-1771
Mailing Address - Fax:
Practice Address - Street 1:3635 E PACES CIR NE
Practice Address - Street 2:UNIT 1414
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-7811
Practice Address - Country:US
Practice Address - Phone:678-316-0957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-06
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27750183500000X
GARPH017876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist