Healthcare Provider Details

I. General information

NPI: 1740280940
Provider Name (Legal Business Name): MANISHA KAUR BAJWA PHARM.D., CGP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 E 12 MILE RD PHARMACY DEPARTMENT
WARREN MI
48093-3472
US

IV. Provider business mailing address

1055 MAYA CT
TROY MI
48085-4967
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-5312
  • Fax:
Mailing address:
  • Phone: 203-306-8062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16079
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number9534
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number1837936
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: