Provider Demographics
NPI:1952948796
Name:GADE, SANDEEP KUMAR
Entity Type:Individual
Prefix:
First Name:SANDEEP
Middle Name:KUMAR
Last Name:GADE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1362 HARTLAND DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5453
Mailing Address - Country:US
Mailing Address - Phone:248-635-1101
Mailing Address - Fax:
Practice Address - Street 1:31200 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-7048
Practice Address - Country:US
Practice Address - Phone:586-238-4570
Practice Address - Fax:586-238-4565
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020374531835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist