Provider Demographics
NPI:1952918211
Name:WARDAK, GULALAI (PHARMD)
Entity Type:Individual
Prefix:
First Name:GULALAI
Middle Name:
Last Name:WARDAK
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 1:1080 SPERRY AVE
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-9267
Mailing Address - Country:US
Mailing Address - Phone:209-892-5584
Mailing Address - Fax:
Practice Address - Street 1:1080 SPERRY AVE
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-9267
Practice Address - Country:US
Practice Address - Phone:209-892-5584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist