Provider Demographics
NPI:1285926899
Name:JOHAL, GURPREET SINGH (RPH)
Entity type:Individual
Prefix:MR
First Name:GURPREET
Middle Name:SINGH
Last Name:JOHAL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14880 NE 24TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5533
Mailing Address - Country:US
Mailing Address - Phone:425-247-4108
Mailing Address - Fax:425-497-8226
Practice Address - Street 1:14880 NE 24TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5533
Practice Address - Country:US
Practice Address - Phone:425-247-4108
Practice Address - Fax:425-497-8226
Is Sole Proprietor?:No
Enumeration Date:2011-05-15
Last Update Date:2011-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00067950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist