MEDICARE: MRS. MANJU BALA BANSAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	VA61277149	WA

General Provider Information

NPI Number	:	1265140040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MANJU BALA BANSAL

Provider Business Mailing Address
First Line	:	4733 17TH AVE NE APT 18
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-4239
Country	:	US
Telephone Number	:	206-551-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4733 17TH AVE NE APT 18
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-4239
Country	:	US
Telephone Number	:	206-551-9600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2022
Last Update Date	:	11/09/2022

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