Provider Demographics
NPI:1134891625
Name:SANDHU, JASKARAN
Entity type:Individual
Prefix:
First Name:JASKARAN
Middle Name:
Last Name:SANDHU
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 1:15325 EDGECLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-2021
Mailing Address - Country:US
Mailing Address - Phone:216-671-6550
Mailing Address - Fax:216-671-6553
Practice Address - Street 1:15325 EDGECLIFF AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-2021
Practice Address - Country:US
Practice Address - Phone:216-671-6550
Practice Address - Fax:216-671-6553
Is Sole Proprietor?:No
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03223067183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist