Provider Demographics
NPI:1245705201
Name:BATRA, AMANDEEP
Entity type:Individual
Prefix:
First Name:AMANDEEP
Middle Name:
Last Name:BATRA
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 1:793 S TRACY BLVD # 165
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-4753
Mailing Address - Country:US
Mailing Address - Phone:209-830-0976
Mailing Address - Fax:
Practice Address - Street 1:1970 W GRANT LINE RD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-8812
Practice Address - Country:US
Practice Address - Phone:209-830-7388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist