Provider Demographics
NPI:1922541499
Name:BAINS, SANDEEP
Entity Type:Individual
Prefix:
First Name:SANDEEP
Middle Name:
Last Name:BAINS
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 1:4600 W MODOC CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-9384
Mailing Address - Country:US
Mailing Address - Phone:559-334-7283
Mailing Address - Fax:
Practice Address - Street 1:7140 W PERSHING CT
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-7941
Practice Address - Country:US
Practice Address - Phone:559-734-2896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist