Healthcare Provider Details

I. General information

NPI: 1124840236
Provider Name (Legal Business Name): AMANPREET KAUR BHATHAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 DELAWARE ST
LONGVIEW WA
98632-2367
US

IV. Provider business mailing address

11420 39TH AVE SE
EVERETT WA
98208-7775
US

V. Phone/Fax

Practice location:
  • Phone: 360-414-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH61568308
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: