=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003538059
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BALVIR SINGH PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2022
-----------------------------------------------------
Last Update Date | 09/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2043 COLLEGE WAY
-----------------------------------------------------
City | FOREST GROVE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97116-1756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-776-0404
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8712 FESTIVAL DR
-----------------------------------------------------
City | ELK GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95624-4573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-776-0404
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PI-0013804
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------