Healthcare Provider Details

I. General information

NPI: 1376477224
Provider Name (Legal Business Name): KOMAL KAUR BAWA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 E GRAND AVE
SOUTH SAN FRANCISCO CA
94080-4808
US

IV. Provider business mailing address

280 E GRAND AVE
SOUTH SAN FRANCISCO CA
94080-4811
US

V. Phone/Fax

Practice location:
  • Phone: 310-560-5662
  • Fax:
Mailing address:
  • Phone: 310-560-5662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH65614
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: