Healthcare Provider Details

I. General information

NPI: 1730775941
Provider Name (Legal Business Name): AMANPREET KAUR GILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2020
Last Update Date: 12/12/2020
Certification Date: 12/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 N AIRPORT RD
WILLOWS CA
95988-9701
US

IV. Provider business mailing address

9344 MIKO CIR
ELK GROVE CA
95624-5025
US

V. Phone/Fax

Practice location:
  • Phone: 530-934-2042
  • Fax:
Mailing address:
  • Phone: 916-233-6411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number83368
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: