Provider Demographics
NPI:1811603335
Name:HUNDAL, KANWER INDERJITSINGH
Entity type:Individual
Prefix:
First Name:KANWER
Middle Name:INDERJITSINGH
Last Name:HUNDAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 W F ST
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3837
Mailing Address - Country:US
Mailing Address - Phone:209-845-9374
Mailing Address - Fax:
Practice Address - Street 1:444 W F ST
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3837
Practice Address - Country:US
Practice Address - Phone:209-845-2820
Practice Address - Fax:209-845-9374
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA874755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist