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General NPI Number Information
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NPI Number | 1104498732
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Entity Type | Individual
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Provider Name | SAMUNDRA BHATTARAI
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Gender | Male
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Dates
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Enumeration Date | 07/13/2021
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Last Update Date | 07/13/2021
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Provider Practice Location Address
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Address Line | 394.3 US-160
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City | KAYENTA
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State | AZ
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Zip | 86033
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Country | US
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Telephone | 928-697-4000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2384
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City | KAYENTA
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State | AZ
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Zip | 86033-2384
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Country | US
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Telephone | 280-602-9226
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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 | 033.0134475
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PHCY-01155
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License Number State | NH
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