Basic Information
Provider Information
NPI: 1790121069
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DHILLON
FirstName: MANPREET
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: PHARMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2620 CHESTER AVE
Address2:  
City: BAKERSFIELD
State: CA
PostalCode: 933012015
CountryCode: US
TelephoneNumber: 6613953000
FaxNumber:  
Practice Location
Address1: 2615 CHESTER AVE
Address2:  
City: BAKERSFIELD
State: CA
PostalCode: 933012014
CountryCode: US
TelephoneNumber: 6613953000
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/14/2013
LastUpdateDate: 05/15/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1835X0200X59739CAN Pharmacy Service ProvidersPharmacistOncology
1835P1200X59739CAY Pharmacy Service ProvidersPharmacistPharmacotherapy

No ID Information.


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