Provider Demographics
NPI:1265590483
Name:GURMUKH SINGH GILL
Entity type:Organization
Organization Name:GURMUKH SINGH GILL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GURMUKH
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:209-632-1111
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:HILMAR
Mailing Address - State:CA
Mailing Address - Zip Code:95324-0189
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8298 LANDER AVE
Practice Address - Street 2:
Practice Address - City:HILMAR
Practice Address - State:CA
Practice Address - Zip Code:95324-8323
Practice Address - Country:US
Practice Address - Phone:209-632-1111
Practice Address - Fax:209-634-0509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY392853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA392850Medicaid
0533869OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA392850Medicaid