Provider Demographics
NPI:1598065591
Name:GITANA, GWEN MADAYAG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GWEN
Middle Name:MADAYAG
Last Name:GITANA
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 1:933 SWEETWATER RD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-4837
Mailing Address - Country:US
Mailing Address - Phone:619-460-6336
Mailing Address - Fax:
Practice Address - Street 1:933 SWEETWATER RD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-4837
Practice Address - Country:US
Practice Address - Phone:619-460-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist