Healthcare Provider Details

I. General information

NPI: 1750191433
Provider Name (Legal Business Name): KEERAT KAUR KANDOLA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7499 DUBLIN BLVD
DUBLIN CA
94568-2415
US

IV. Provider business mailing address

985 SILVER BIRCH LN
HAYWARD CA
94544-6683
US

V. Phone/Fax

Practice location:
  • Phone: 925-556-4034
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number90120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: