Provider Demographics
NPI:1730207770
Name:PHADKE, SANTOSH MUKTESH (MS PHARMACOLOGY)
Entity type:Individual
Prefix:
First Name:SANTOSH
Middle Name:MUKTESH
Last Name:PHADKE
Suffix:
Gender:M
Credentials:MS PHARMACOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 MILLSTONE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1649
Mailing Address - Country:US
Mailing Address - Phone:248-778-6673
Mailing Address - Fax:
Practice Address - Street 1:3 SOUTH TELEGRAPH ROAD
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341
Practice Address - Country:US
Practice Address - Phone:248-338-2665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist