Provider Demographics
NPI:1356157705
Name:DHALIWAL, KUMERPREET KAUR
Entity type:Individual
Prefix:
First Name:KUMERPREET
Middle Name:KAUR
Last Name:DHALIWAL
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 1:380 ALCANTAR CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-2702
Mailing Address - Country:US
Mailing Address - Phone:916-807-0631
Mailing Address - Fax:
Practice Address - Street 1:2010 ALAMO DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6289
Practice Address - Country:US
Practice Address - Phone:707-451-8304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90299183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist