Provider Demographics
NPI:1174804538
Name:KALSI, HARCHARAN
Entity type:Individual
Prefix:MR
First Name:HARCHARAN
Middle Name:
Last Name:KALSI
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 1:5732 WEDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3316
Mailing Address - Country:US
Mailing Address - Phone:313-724-8382
Mailing Address - Fax:313-724-8375
Practice Address - Street 1:5732 WEDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3316
Practice Address - Country:US
Practice Address - Phone:313-724-8382
Practice Address - Fax:313-724-8375
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist