Healthcare Provider Details

I. General information

NPI: 1356797765
Provider Name (Legal Business Name): GAGANDEEP PUAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5619 174TH ST
FRESH MEADOWS NY
11365-1617
US

IV. Provider business mailing address

5619 174TH ST
FRESH MEADOWS NY
11365-1617
US

V. Phone/Fax

Practice location:
  • Phone: 516-430-1086
  • Fax:
Mailing address:
  • Phone: 516-430-1086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number058736
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: