Provider Demographics
NPI:1043356090
Name:MOWRY PLAZA PHARMACY
Entity Type:Organization
Organization Name:MOWRY PLAZA PHARMACY
Other - Org Name:GURPARTAP SINGH BASRAI
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GURPARTAP
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:BASRAI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:510-745-9900
Mailing Address - Street 1:668 MOWRY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4113
Mailing Address - Country:US
Mailing Address - Phone:510-745-9900
Mailing Address - Fax:510-745-9950
Practice Address - Street 1:668 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4113
Practice Address - Country:US
Practice Address - Phone:510-745-9900
Practice Address - Fax:510-745-9950
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HALLER'S PHARMACY & MEDICAL SUPPLY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-29
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31057183500000X
CAPHY454523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA454520Medicaid
CAPHA454520Medicaid