Provider Demographics
NPI:1942595087
Name:SAMPAT, DHANANJAY MAHESH (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:DHANANJAY
Middle Name:MAHESH
Last Name:SAMPAT
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:MR
Other - First Name:JAY
Other - Middle Name:MAHESH
Other - Last Name:SAMPAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:6750 CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-1717
Mailing Address - Country:US
Mailing Address - Phone:562-295-2972
Mailing Address - Fax:
Practice Address - Street 1:6750 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-1717
Practice Address - Country:US
Practice Address - Phone:562-295-2972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist