Provider Demographics
NPI:1902198229
Name:VALLABH, KESHENI
Entity Type:Individual
Prefix:MRS
First Name:KESHENI
Middle Name:
Last Name:VALLABH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 E CHAMPLAIN DR
Mailing Address - Street 2:APT 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-5085
Mailing Address - Country:US
Mailing Address - Phone:559-312-0912
Mailing Address - Fax:
Practice Address - Street 1:2640 FLORAL AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-2602
Practice Address - Country:US
Practice Address - Phone:559-896-7105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65278183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist