Provider Demographics
NPI:1720393564
Name:GRANDHI, SIVANAND
Entity Type:Individual
Prefix:
First Name:SIVANAND
Middle Name:
Last Name:GRANDHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 VENTNOR AVE
Mailing Address - Street 2:
Mailing Address - City:VENTNOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08406-2151
Mailing Address - Country:US
Mailing Address - Phone:609-487-8800
Mailing Address - Fax:609-487-7531
Practice Address - Street 1:6701 VENTNOR AVE
Practice Address - Street 2:
Practice Address - City:VENTNOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08406-2151
Practice Address - Country:US
Practice Address - Phone:609-487-8800
Practice Address - Fax:609-487-7531
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03190100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist