Healthcare Provider Details

I. General information

NPI: 1942554530
Provider Name (Legal Business Name): GAKS PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2012
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 BALBOA BLVD # 101
GRANADA HILLS CA
91344-5001
US

IV. Provider business mailing address

10700 BALBOA BLVD # 101
GRANADA HILLS CA
91344-5001
US

V. Phone/Fax

Practice location:
  • Phone: 818-831-2090
  • Fax:
Mailing address:
  • Phone: 818-831-2090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY51136
License Number StateCA

VIII. Authorized Official

Name: EUN JOO GAK
Title or Position: PRESIDENT
Credential: PHARM.D.
Phone: 818-831-2090