Provider Demographics
NPI:1356745756
Name:KAUR, MANTESH (RPH)
Entity type:Individual
Prefix:
First Name:MANTESH
Middle Name:
Last Name:KAUR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-3935
Mailing Address - Country:US
Mailing Address - Phone:732-485-4896
Mailing Address - Fax:
Practice Address - Street 1:240 US HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-3506
Practice Address - Country:US
Practice Address - Phone:973-379-0766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03666300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist