Provider Demographics
NPI:1548091291
Name:WARDAK, GURBET
Entity type:Individual
Prefix:
First Name:GURBET
Middle Name:
Last Name:WARDAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 EUCLID AVE APT 307
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2471
Mailing Address - Country:US
Mailing Address - Phone:847-922-1485
Mailing Address - Fax:
Practice Address - Street 1:24865 EMERY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-5636
Practice Address - Country:US
Practice Address - Phone:216-750-3906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3444649183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist