MEDICARE: GERARD ENCENAREAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	82479	CA

General Provider Information

NPI Number	:	1457961245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERARD ENCENAREAL

Provider Business Mailing Address
First Line	:	3800 MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-3602
Country	:	US
Telephone Number	:	310-637-2509
Fax Number	:

Provider Business Practice Location Address
First Line	:	3208 E FLORENCE AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5832
Country	:	US
Telephone Number	:	323-589-1916
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2020
Last Update Date	:	10/18/2020

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Directions to “ GERARD ENCENAREAL ” Practice Location

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