Provider Demographics
NPI:1972825800
Name:BAMRAH, MALKIT SINGH KIRPAL SINGH (RPH)
Entity Type:Individual
Prefix:
First Name:MALKIT SINGH
Middle Name:KIRPAL SINGH
Last Name:BAMRAH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 O'NEILL DRIVE
Mailing Address - Street 2:KMART PHARMACY-3938
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-1821
Mailing Address - Country:US
Mailing Address - Phone:517-789-7988
Mailing Address - Fax:517-780-0399
Practice Address - Street 1:3555 ONEIL DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-1821
Practice Address - Country:US
Practice Address - Phone:517-789-7988
Practice Address - Fax:517-780-0399
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034183183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist