Healthcare Provider Details

I. General information

NPI: 1629733068
Provider Name (Legal Business Name): GURMANPREET KAUR SIDHU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ANN ARBOR RD W
PLYMOUTH MI
48170-2127
US

IV. Provider business mailing address

800 ANN ARBOR RD W
PLYMOUTH MI
48170-2127
US

V. Phone/Fax

Practice location:
  • Phone: 734-737-0218
  • Fax:
Mailing address:
  • Phone: 734-773-7021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5303037243
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: