Provider Demographics
NPI:1740747526
Name:PATEL, SANJAY KHUSHAL (PHAM D)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:KHUSHAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHAM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1495
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-0149
Mailing Address - Country:US
Mailing Address - Phone:925-895-3287
Mailing Address - Fax:925-846-8057
Practice Address - Street 1:1550 E 14TH ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4807
Practice Address - Country:US
Practice Address - Phone:510-351-7957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist