Provider Demographics
NPI:1215770912
Name:SIDHU, GUNJEET KAUR (RPH)
Entity type:Individual
Prefix:
First Name:GUNJEET
Middle Name:KAUR
Last Name:SIDHU
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:PO BOX 340246
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-0246
Mailing Address - Country:US
Mailing Address - Phone:916-848-8124
Mailing Address - Fax:
Practice Address - Street 1:1501 HELEN POWER DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-3351
Practice Address - Country:US
Practice Address - Phone:707-451-1396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist