Provider Demographics
NPI:1962154617
Name:SARDANA, JAY
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:SARDANA
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 1:101 SOUTHWESTERN BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3548
Mailing Address - Country:US
Mailing Address - Phone:832-939-3550
Mailing Address - Fax:
Practice Address - Street 1:101 SOUTHWESTERN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3548
Practice Address - Country:US
Practice Address - Phone:832-939-3550
Practice Address - Fax:832-939-3560
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist