Provider Demographics
NPI:1487958849
Name:MIDHA, GAURAV (RPH)
Entity type:Individual
Prefix:
First Name:GAURAV
Middle Name:
Last Name:MIDHA
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 1:515 N ESPLANADE ST
Mailing Address - Street 2:
Mailing Address - City:CUERO
Mailing Address - State:TX
Mailing Address - Zip Code:77954-3603
Mailing Address - Country:US
Mailing Address - Phone:253-905-6881
Mailing Address - Fax:
Practice Address - Street 1:1020 23RD ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-4631
Practice Address - Country:US
Practice Address - Phone:409-877-7029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52524183500000X
WAPH60149532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist