Provider Demographics
NPI:1013695766
Name:GHOTRA, MANPREET KAUR
Entity type:Individual
Prefix:
First Name:MANPREET
Middle Name:KAUR
Last Name:GHOTRA
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 1:604 MEREDITH ST
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-2913
Mailing Address - Country:US
Mailing Address - Phone:347-475-6697
Mailing Address - Fax:
Practice Address - Street 1:5905 DOLLARWAY RD
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71602-3825
Practice Address - Country:US
Practice Address - Phone:870-534-7868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD16650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist