Provider Demographics
NPI:1255978581
Name:SANDHU, GAGANPREET KAUR (PHARMD)
Entity type:Individual
Prefix:
First Name:GAGANPREET
Middle Name:KAUR
Last Name:SANDHU
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 1:506 VINA CT
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:CA
Mailing Address - Zip Code:95334-9111
Mailing Address - Country:US
Mailing Address - Phone:209-631-1925
Mailing Address - Fax:
Practice Address - Street 1:1830 MITCHELL RD
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-2163
Practice Address - Country:US
Practice Address - Phone:209-538-4927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81017183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist