Provider Demographics
NPI:1881378792
Name:JALUDI, SUMAYA TAREG (RPH)
Entity type:Individual
Prefix:
First Name:SUMAYA
Middle Name:TAREG
Last Name:JALUDI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34524 BLUESTONE CMN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-3272
Mailing Address - Country:US
Mailing Address - Phone:415-528-0564
Mailing Address - Fax:
Practice Address - Street 1:46848 MISSION BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-7943
Practice Address - Country:US
Practice Address - Phone:510-497-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist