Healthcare Provider Details

I. General information

NPI: 1265590483
Provider Name (Legal Business Name): GURMUKH SINGH GILL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8298 LANDER AVE
HILMAR CA
95324-8323
US

IV. Provider business mailing address

PO BOX 189
HILMAR CA
95324-0189
US

V. Phone/Fax

Practice location:
  • Phone: 209-632-1111
  • Fax: 209-634-0509
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY39285
License Number StateCA

VIII. Authorized Official

Name: GURMUKH GILL
Title or Position: OWNER
Credential: RPH
Phone: 209-632-1111