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General NPI Number Information
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NPI Number | 1902562291
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Entity Type | Individual
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Provider Name | GURSIMRAN SINGH WALIA
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Gender | Male
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Dates
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Enumeration Date | 11/11/2021
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Last Update Date | 11/11/2021
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Provider Practice Location Address
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Address Line | 1801 W 11TH ST
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City | TRACY
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State | CA
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Zip | 95376-3727
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Country | US
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Telephone | 209-830-2950
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Fax |
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Provider Business Mailing Address
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Address Line | 33209 GREAT SALT LAKE DR
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City | FREMONT
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State | CA
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Zip | 94555-1209
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Country | US
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Telephone | 510-648-5936
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 85536
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License Number State | CA
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