Healthcare Provider Details

I. General information

NPI: 1548827074
Provider Name (Legal Business Name): JAGDEEP BHULLAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MOUNT VERNON AVE
BAKERSFIELD CA
93306-4018
US

IV. Provider business mailing address

3703 COLLINGWOOD DR
BAKERSFIELD CA
93311-8757
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-5567
  • Fax: 661-862-7684
Mailing address:
  • Phone: 661-378-3466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number81724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: