Provider Demographics
NPI:1629352422
Name:BADHESHA, AMANDIP SINGH
Entity Type:Individual
Prefix:
First Name:AMANDIP
Middle Name:SINGH
Last Name:BADHESHA
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 1:4771 W ASHLAN AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-4307
Mailing Address - Country:US
Mailing Address - Phone:559-274-0559
Mailing Address - Fax:559-274-0565
Practice Address - Street 1:4771 W ASHLAN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-4307
Practice Address - Country:US
Practice Address - Phone:559-274-0559
Practice Address - Fax:559-274-0565
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61301183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist