Provider Demographics
NPI:1891072856
Name:DHADLI, HARDEEP SINGH
Entity Type:Individual
Prefix:
First Name:HARDEEP
Middle Name:SINGH
Last Name:DHADLI
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 1:4242 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:CA
Mailing Address - Zip Code:95953-9400
Mailing Address - Country:US
Mailing Address - Phone:530-682-2102
Mailing Address - Fax:530-671-1135
Practice Address - Street 1:6020 CLARK RD
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4152
Practice Address - Country:US
Practice Address - Phone:530-877-7001
Practice Address - Fax:530-877-2740
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47159183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist