Provider Demographics
NPI:1891947354
Name:SIDHU, MANDEEP (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MANDEEP
Middle Name:
Last Name:SIDHU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 RICHARDSON DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-6462
Mailing Address - Country:US
Mailing Address - Phone:407-257-3767
Mailing Address - Fax:
Practice Address - Street 1:715 RICHARDSON DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-6462
Practice Address - Country:US
Practice Address - Phone:407-257-3767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA566581835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist