Provider Demographics
NPI:1972889244
Name:GANDHI, PINAK
Entity type:Individual
Prefix:
First Name:PINAK
Middle Name:
Last Name:GANDHI
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 1:867 E RIVER PKWY
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-4145
Mailing Address - Country:US
Mailing Address - Phone:408-396-9200
Mailing Address - Fax:408-274-8580
Practice Address - Street 1:1693 FLANIGAN DR STE 104
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1683
Practice Address - Country:US
Practice Address - Phone:408-274-6698
Practice Address - Fax:408-274-8580
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist