Organization
GERALD J WALDE
Active
Other names
WALDES DESERT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY WALDE PHARMD (PHARMACIST OWNER)
(760) 868-6526
Entity
Organization
Contact information
Practice address
9723 SIERRA VISTA RD, STE E, PHELAN, CA 92371-8271
(760) 868-6526
(760) 868-6868
Mailing address
PO BOX 1970, WRIGHTWOOD, CA 92397-1970
(760) 249-3081
(760) 868-6868
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY41829
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2005485
PK
—
05
—
PHA418290
—
CA
Enumeration date
08/31/2006
Last updated
11/17/2015
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