Provider Demographics
NPI:1770199044
Name:DALSANIA, SURAJ (RPH)
Entity Type:Individual
Prefix:
First Name:SURAJ
Middle Name:
Last Name:DALSANIA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2973 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3425
Mailing Address - Country:US
Mailing Address - Phone:805-682-3761
Mailing Address - Fax:805-682-8349
Practice Address - Street 1:2973 STATE ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3425
Practice Address - Country:US
Practice Address - Phone:805-682-3761
Practice Address - Fax:805-682-8349
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist