Healthcare Provider Details

I. General information

NPI: 1033685276
Provider Name (Legal Business Name): MICHEL GELLAD PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 04/16/2023
Certification Date: 04/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 GREEN VALLEY RD
CAMERON PARK CA
95682-7658
US

IV. Provider business mailing address

111 HAMILTON CT
GRANITE BAY CA
95746-6474
US

V. Phone/Fax

Practice location:
  • Phone: 530-676-6352
  • Fax:
Mailing address:
  • Phone: 916-396-3740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number79667
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: