Provider Demographics
NPI:1598075756
Name:PAIK, AMANDEEP KAUR
Entity Type:Individual
Prefix:
First Name:AMANDEEP KAUR
Middle Name:
Last Name:PAIK
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 1:1009 S 41ST AVE
Mailing Address - Street 2:APT # 1
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3818
Mailing Address - Country:US
Mailing Address - Phone:541-255-2762
Mailing Address - Fax:
Practice Address - Street 1:5606 SUMMITVIEW AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3038
Practice Address - Country:US
Practice Address - Phone:509-965-2037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60000916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist