Provider Demographics
NPI:1245942473
Name:BASRA, AMANDEEP KAUR
Entity type:Individual
Prefix:
First Name:AMANDEEP
Middle Name:KAUR
Last Name:BASRA
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 1:32015 PACIFIC HWY S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6001
Mailing Address - Country:US
Mailing Address - Phone:253-945-6011
Mailing Address - Fax:253-946-0285
Practice Address - Street 1:32015 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6001
Practice Address - Country:US
Practice Address - Phone:253-945-6011
Practice Address - Fax:253-946-0285
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA60198072183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician