Provider Demographics
NPI:1881029106
Name:SOOD, SANJEEV (RPH)
Entity Type:Individual
Prefix:MR
First Name:SANJEEV
Middle Name:
Last Name:SOOD
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 1:1890 COOL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-7956
Mailing Address - Country:US
Mailing Address - Phone:630-901-9133
Mailing Address - Fax:630-377-2411
Practice Address - Street 1:1890 COOL CREEK DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-7956
Practice Address - Country:US
Practice Address - Phone:630-901-9133
Practice Address - Fax:630-377-2411
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.292387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist