Provider Demographics
NPI:1912644410
Name:AGUIRRE, GIZELLE ADINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:GIZELLE
Middle Name:ADINA
Last Name:AGUIRRE
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 1:2224 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-9647
Mailing Address - Country:US
Mailing Address - Phone:209-869-6499
Mailing Address - Fax:
Practice Address - Street 1:2224 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-9647
Practice Address - Country:US
Practice Address - Phone:209-869-6499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANAMedicaid