Healthcare Provider Details

I. General information

NPI: 1306116413
Provider Name (Legal Business Name): MRS. HARDIP KAUR SAHOTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2995 SAN PABLO AVE
BERKELEY CA
94702-2465
US

IV. Provider business mailing address

1211 67TH ST
EMERYVILLE CA
94608-1120
US

V. Phone/Fax

Practice location:
  • Phone: 510-548-2104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH52581
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: