Provider Demographics
NPI:1841977329
Name:GANGULA, NAJU
Entity type:Individual
Prefix:MS
First Name:NAJU
Middle Name:
Last Name:GANGULA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NAJU
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4204 BALLARD CIR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-8406
Mailing Address - Country:US
Mailing Address - Phone:951-255-8638
Mailing Address - Fax:
Practice Address - Street 1:4204 BALLARD CIR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-8406
Practice Address - Country:US
Practice Address - Phone:951-255-8638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist