Healthcare Provider Details

I. General information

NPI: 1972495083
Provider Name (Legal Business Name): GELLAN KASHOU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17777 CENTER COURT DR N
CERRITOS CA
90703-9320
US

IV. Provider business mailing address

4552 VICTORIA CT
CYPRESS CA
90630-3505
US

V. Phone/Fax

Practice location:
  • Phone: 877-577-4844
  • Fax:
Mailing address:
  • Phone: 714-869-6162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number80135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: