Provider Demographics
NPI:1356942601
Name:DALSANIA, PINA K
Entity type:Individual
Prefix:
First Name:PINA
Middle Name:K
Last Name:DALSANIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7014 BRIDGEMILL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-1299
Mailing Address - Country:US
Mailing Address - Phone:404-538-0787
Mailing Address - Fax:
Practice Address - Street 1:5448 WHITTLESEY BLVD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-7298
Practice Address - Country:US
Practice Address - Phone:706-649-6322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist