Provider Demographics
NPI:1629569645
Name:DHILLON, ARSHDEEP SINGH
Entity Type:Individual
Prefix:DR
First Name:ARSHDEEP
Middle Name:SINGH
Last Name:DHILLON
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 1:350 W CENTRAL AVE APT 2105
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-9055
Mailing Address - Country:US
Mailing Address - Phone:209-914-0254
Mailing Address - Fax:
Practice Address - Street 1:3848 MCHENRY AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-1586
Practice Address - Country:US
Practice Address - Phone:209-340-0960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77564OtherCALIFORNIA PHARMACIST LICENSE