Provider Demographics
NPI:1215024260
Name:DERGALUST, SUNITA (PHARMD, BCPS)
Entity Type:Individual
Prefix:DR
First Name:SUNITA
Middle Name:
Last Name:DERGALUST
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5626 SIENNA WAY
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-7193
Mailing Address - Country:US
Mailing Address - Phone:310-268-3244
Mailing Address - Fax:310-268-4611
Practice Address - Street 1:11301 WILSHIRE BLVD # 119
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-268-3244
Practice Address - Fax:310-268-4611
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000177861835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy