Provider Demographics
NPI:1669884938
Name:GILL, GAGANDEEP S (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GAGANDEEP
Middle Name:S
Last Name:GILL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 S TRACY BLVD
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-9102
Mailing Address - Country:US
Mailing Address - Phone:209-830-6800
Mailing Address - Fax:209-830-8811
Practice Address - Street 1:2550 S TRACY BLVD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-9102
Practice Address - Country:US
Practice Address - Phone:209-830-6800
Practice Address - Fax:209-830-8811
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist