Provider Demographics
NPI:1720353295
Name:DREDAR, SASI A (RPH)
Entity Type:Individual
Prefix:DR
First Name:SASI
Middle Name:A
Last Name:DREDAR
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:PO BOX 77844
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-1144
Mailing Address - Country:US
Mailing Address - Phone:209-956-5456
Mailing Address - Fax:
Practice Address - Street 1:2049 ANGELICO CIR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8808
Practice Address - Country:US
Practice Address - Phone:209-956-5456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-17
Last Update Date:2012-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42560183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist