Provider Demographics
NPI:1275201378
Name:SINGH, MANDIP KAUR
Entity Type:Individual
Prefix:
First Name:MANDIP
Middle Name:KAUR
Last Name:SINGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 N NAGLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-3621
Mailing Address - Country:US
Mailing Address - Phone:773-774-2225
Mailing Address - Fax:773-774-4719
Practice Address - Street 1:6310 N NAGLE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-3621
Practice Address - Country:US
Practice Address - Phone:773-774-2225
Practice Address - Fax:773-774-4719
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051304246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist