Provider Demographics
NPI:1306200688
Name:PARBHOO, MUKESH
Entity Type:Individual
Prefix:
First Name:MUKESH
Middle Name:
Last Name:PARBHOO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 HIDDEN VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3901
Mailing Address - Country:US
Mailing Address - Phone:951-734-4181
Mailing Address - Fax:
Practice Address - Street 1:1101 HIDDEN VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3901
Practice Address - Country:US
Practice Address - Phone:951-734-4181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist