Provider Demographics
NPI:1760766877
Name:VIRDI, DALJIT (RPH)
Entity Type:Individual
Prefix:MS
First Name:DALJIT
Middle Name:
Last Name:VIRDI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48246 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4069
Mailing Address - Country:US
Mailing Address - Phone:586-997-6903
Mailing Address - Fax:
Practice Address - Street 1:32201 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-1408
Practice Address - Country:US
Practice Address - Phone:586-293-5152
Practice Address - Fax:586-293-7839
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist