Provider Demographics
NPI:1437733052
Name:PODRAZA, GABRIEL (PHARMD)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:PODRAZA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 142ND ST UNIT 203
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50323-2039
Mailing Address - Country:US
Mailing Address - Phone:712-299-3997
Mailing Address - Fax:
Practice Address - Street 1:3414 8TH ST SW
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1024
Practice Address - Country:US
Practice Address - Phone:515-967-1885
Practice Address - Fax:515-412-3066
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist