Provider Demographics
NPI:1669757209
Name:ATWAL, KIRAN V (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:KIRAN
Middle Name:V
Last Name:ATWAL
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:MRS
Other - First Name:KIRAN
Other - Middle Name:V
Other - Last Name:ATWAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:1815 HERNDON AVE
Mailing Address - Street 2:WALGREENS PHARMACY
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6109
Mailing Address - Country:US
Mailing Address - Phone:559-325-1324
Mailing Address - Fax:559-325-1909
Practice Address - Street 1:1815 HERNDON AVE--WALGREENS
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611
Practice Address - Country:US
Practice Address - Phone:559-325-1324
Practice Address - Fax:559-325-1909
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist