Provider Demographics
NPI:1710492673
Name:PANDYA, SANTOSH N (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SANTOSH
Middle Name:N
Last Name:PANDYA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-9120
Mailing Address - Country:US
Mailing Address - Phone:734-728-4030
Mailing Address - Fax:734-728-4037
Practice Address - Street 1:16311 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-1825
Practice Address - Country:US
Practice Address - Phone:313-838-1100
Practice Address - Fax:313-838-1103
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1649404526Medicaid
MI1902143118Medicaid