Provider Demographics
NPI:1144868647
Name:KAUR, KOMALPREET (RPH)
Entity type:Individual
Prefix:DR
First Name:KOMALPREET
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 1:4941 WAGON WHEEL WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94803-3820
Mailing Address - Country:US
Mailing Address - Phone:510-323-5444
Mailing Address - Fax:
Practice Address - Street 1:1444 SHATTUCK PLACE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709
Practice Address - Country:US
Practice Address - Phone:510-542-5242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist