Provider Demographics
NPI:1295373132
Name:MALHOTRA, DEEPAK (RPH)
Entity Type:Individual
Prefix:DR
First Name:DEEPAK
Middle Name:
Last Name:MALHOTRA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3154 KEATS AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-8922
Mailing Address - Country:US
Mailing Address - Phone:559-578-5194
Mailing Address - Fax:
Practice Address - Street 1:1113 E CHAMPLAIN DR
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-4223
Practice Address - Country:US
Practice Address - Phone:559-434-2158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist