Provider Demographics
NPI:1295186849
Name:MANGAT, UMERDEEP
Entity Type:Individual
Prefix:
First Name:UMERDEEP
Middle Name:
Last Name:MANGAT
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 1:36868 TURTLE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1230
Mailing Address - Country:US
Mailing Address - Phone:248-462-0878
Mailing Address - Fax:
Practice Address - Street 1:36868 TURTLE CREEK CT
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-1230
Practice Address - Country:US
Practice Address - Phone:248-462-0878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist