Healthcare Provider Details

I. General information

NPI: 1770148504
Provider Name (Legal Business Name): GURPREET KAUR SRAI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 SHATTUCK AVE
BERKELEY CA
94709-1410
US

IV. Provider business mailing address

3800 DALE RD
MODESTO CA
95356-8627
US

V. Phone/Fax

Practice location:
  • Phone: 510-849-0484
  • Fax:
Mailing address:
  • Phone: 209-914-9361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number79386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: