Healthcare Provider Details

I. General information

NPI: 1972407880
Provider Name (Legal Business Name): FRED DOWLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 W REDONDO BEACH BLVD
GARDENA CA
90247-3200
US

IV. Provider business mailing address

1630 W REDONDO BEACH BLVD
GARDENA CA
90247-3200
US

V. Phone/Fax

Practice location:
  • Phone: 310-538-2885
  • Fax: 310-538-0609
Mailing address:
  • Phone: 310-538-2885
  • Fax: 310-538-0609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number50550
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: