Gangadar Gubba, PHARM.D

Primary specialty

PharmacistTaxonomy code 183500000X

License

PH60128771 Issued in WA

Practice address

2720 S Quillan Street
Wal-Mart Pharmacy (Store: 2101)
Kennewick, WA 99337-9702

Phone

(509) 586-1574

Fax

(509) 585-1413

NPI assigned

Sep 7, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473206400000",
    "number": "1114474103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2720 S QUILLAN STREET",
            "address_2": "WAL-MART PHARMACY (STORE: 2101)",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993379702",
            "telephone_number": "509-586-1574",
            "fax_number": "509-585-1413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2720 S QUILLAN STREET",
            "address_2": "WAL-MART PHARMACY (STORE: 2101)",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993379702",
            "telephone_number": "509-586-1574",
            "fax_number": "509-585-1413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUBBA",
        "first_name": "GANGADAR",
        "name_prefix": "Mr.",
        "credential": "PHARM.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-09-07",
        "last_updated": "2016-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "PH60128771",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OR",
            "license": "RPH-0012606",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Kennewick, WA
• Providers in Kennewick, WA by specialty
• Pharmacist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.