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General NPI Number Information
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NPI Number | 1013695766
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Entity Type | Individual
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Provider Name | MANPREET KAUR GHOTRA
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Gender | Female
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Dates
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Enumeration Date | 07/11/2023
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 5905 DOLLARWAY RD
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City | PINE BLUFF
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State | AR
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Zip | 71602-3825
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Country | US
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Telephone | 870-534-7868
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Fax |
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Provider Business Mailing Address
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Address Line | 604 MEREDITH ST
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City | WHITE HALL
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State | AR
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Zip | 71602-2913
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Country | US
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Telephone | 347-475-6697
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PD16650
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License Number State | AR
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