Provider Demographics
NPI:1073829115
Name:BAINS, KOMAL G K (RPH)
Entity Type:Individual
Prefix:MS
First Name:KOMAL
Middle Name:G K
Last Name:BAINS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4151 MOUNTAIN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-8342
Mailing Address - Country:US
Mailing Address - Phone:209-985-5835
Mailing Address - Fax:
Practice Address - Street 1:4601 DALE RD
Practice Address - Street 2:INPATIENT PHARMACY
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9718
Practice Address - Country:US
Practice Address - Phone:209-735-3967
Practice Address - Fax:209-735-6348
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 54982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist