Provider Demographics
NPI:1295226868
Name:ATWAL, GAGANDEEP KAUR (PHARMD)
Entity Type:Individual
Prefix:
First Name:GAGANDEEP
Middle Name:KAUR
Last Name:ATWAL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1258 SUNSET BLVD APT 4E
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-7803
Mailing Address - Country:US
Mailing Address - Phone:440-865-6424
Mailing Address - Fax:
Practice Address - Street 1:3537 US HIGHWAY 84
Practice Address - Street 2:
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516-2237
Practice Address - Country:US
Practice Address - Phone:912-449-0811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-19
Last Update Date:2018-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist