Provider Demographics
NPI:1295011252
Name:SHERGILL-HIRSH, ANTARA (RPH)
Entity Type:Individual
Prefix:
First Name:ANTARA
Middle Name:
Last Name:SHERGILL-HIRSH
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:PO BOX 3776
Mailing Address - Street 2:
Mailing Address - City:INCLINE VILLAGE
Mailing Address - State:NV
Mailing Address - Zip Code:89450-3776
Mailing Address - Country:US
Mailing Address - Phone:775-832-2452
Mailing Address - Fax:
Practice Address - Street 1:11290 DONNER PASS RD
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4808
Practice Address - Country:US
Practice Address - Phone:530-582-7952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52264183500000X
NV17073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist