Healthcare Provider Details

I. General information

NPI: 1669757209
Provider Name (Legal Business Name): KIRAN V ATWAL PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRAN V ATWAL PHARMACIST

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 HERNDON AVE--WALGREENS
CLOVIS CA
93611
US

IV. Provider business mailing address

1815 HERNDON AVE WALGREENS PHARMACY
CLOVIS CA
93611-6109
US

V. Phone/Fax

Practice location:
  • Phone: 559-325-1324
  • Fax: 559-325-1909
Mailing address:
  • Phone: 559-325-1324
  • Fax: 559-325-1909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: