Gerald J Walde

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY41829 Issued in CA

Legal business name

GERALD J WALDE

Doing business as

Waldes Desert Pharmacy

Practice address

9723 Sierra Vista Rd
Ste E
Phelan, CA 92371-8271

Phone

(760) 868-6526

Fax

(760) 868-6868

NPI assigned

Aug 31, 2006

Last updated

Nov 17, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jerry Walde, PHARMD

Title

Pharmacist Owner

Phone

(760) 868-6526

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• WALDES DESERT PHARMACY Doing business as

Locations

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447718400000",
    "number": "1326150244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1970",
            "city": "WRIGHTWOOD",
            "state": "CA",
            "postal_code": "923971970",
            "telephone_number": "760-249-3081",
            "fax_number": "760-868-6868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9723 SIERRA VISTA RD",
            "address_2": "STE E",
            "city": "PHELAN",
            "state": "CA",
            "postal_code": "923718271",
            "telephone_number": "760-868-6526",
            "fax_number": "760-868-6868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GERALD J WALDE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2015-11-17",
        "status": "A",
        "authorized_official_last_name": "WALDE",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "PHARMACIST OWNER",
        "authorized_official_telephone_number": "760-868-6526",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY41829",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2005485",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA418290",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALDES DESERT PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Phelan, CA
• Providers in Phelan, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2015; 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.