Healthcare Provider Details

I. General information

NPI: 1316935364
Provider Name (Legal Business Name): JOHN L SILBERSTEIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12555 GARDEN GROVE BLVD #102
GARDEN GROVE CA
92843-1902
US

IV. Provider business mailing address

12555 GARDEN GROVE BLVD #102
GARDEN GROVE CA
92843-1902
US

V. Phone/Fax

Practice location:
  • Phone: 714-636-0593
  • Fax: 714-636-7708
Mailing address:
  • Phone: 714-636-0593
  • Fax: 714-636-7708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHY30791
License Number StateCA

VIII. Authorized Official

Name: MR. JOHN L SILBERSTEIN
Title or Position: PHARMACIST - OWNER
Credential: RPH
Phone: 714-636-0593