Provider Demographics
NPI:1205663622
Name:DHILLON, SIMRAN
Entity type:Individual
Prefix:
First Name:SIMRAN
Middle Name:
Last Name:DHILLON
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 1:7825 HYDE RD
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-9666
Mailing Address - Country:US
Mailing Address - Phone:916-430-1342
Mailing Address - Fax:
Practice Address - Street 1:2090 HARBISON DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-3902
Practice Address - Country:US
Practice Address - Phone:707-452-7277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist