Provider Demographics
NPI:1942477500
Name:PANDYA, PRADEEP N (RPH)
Entity Type:Individual
Prefix:MR
First Name:PRADEEP
Middle Name:N
Last Name:PANDYA
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 1:6241 MOONSTONE CT
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7815
Mailing Address - Country:US
Mailing Address - Phone:810-953-4297
Mailing Address - Fax:
Practice Address - Street 1:1124 N BALLENGER HWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-7516
Practice Address - Country:US
Practice Address - Phone:810-233-6765
Practice Address - Fax:810-233-6582
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist