Provider Demographics
NPI:1962774471
Name:BAL, DEVINDER KAUR (RPH)
Entity type:Individual
Prefix:
First Name:DEVINDER
Middle Name:KAUR
Last Name:BAL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:DEVINDER
Other - Middle Name:
Other - Last Name:BAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:1238 CHANCERY WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5786
Mailing Address - Country:US
Mailing Address - Phone:925-803-9616
Mailing Address - Fax:
Practice Address - Street 1:1238 CHANCERY WAY
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-5786
Practice Address - Country:US
Practice Address - Phone:925-803-9616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA558651835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist