Provider Demographics
NPI:1295518017
Name:SATHAPPAN, VIJAY MANI (PHARMD)
Entity type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:MANI
Last Name:SATHAPPAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 SHADY CHARMER AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-8690
Mailing Address - Country:US
Mailing Address - Phone:702-882-8294
Mailing Address - Fax:
Practice Address - Street 1:5875 E FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-5450
Practice Address - Country:US
Practice Address - Phone:208-461-8718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP10772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist