Provider Demographics
NPI:1821841933
Name:PHAGURA, MANDEEP SINGH
Entity Type:Individual
Prefix:
First Name:MANDEEP
Middle Name:SINGH
Last Name:PHAGURA
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 1:1962 MICHELLE DR
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-7172
Mailing Address - Country:US
Mailing Address - Phone:530-701-9470
Mailing Address - Fax:
Practice Address - Street 1:2780 ESPLANADE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-1115
Practice Address - Country:US
Practice Address - Phone:530-345-9009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88587183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist