Provider Demographics
NPI:1154921096
Name:BOPARAI, MANMOHAN SINGH
Entity type:Individual
Prefix:
First Name:MANMOHAN
Middle Name:SINGH
Last Name:BOPARAI
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 1:50 N MACDADE BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-1223
Mailing Address - Country:US
Mailing Address - Phone:201-290-8182
Mailing Address - Fax:
Practice Address - Street 1:50 N MACDADE BLVD
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036-1223
Practice Address - Country:US
Practice Address - Phone:610-583-2206
Practice Address - Fax:610-583-2208
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP450141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist