Healthcare Provider Details

I. General information

NPI: 1265461206
Provider Name (Legal Business Name): GELSONS MARKETS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25636 CROWN VALLEY PKWY
LADERA RANCH CA
92694-0464
US

IV. Provider business mailing address

25636 CROWN VALLEY PKWY
LADERA RANCH CA
92694-0464
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-1914
  • Fax: 949-364-1833
Mailing address:
  • Phone: 949-364-1914
  • Fax: 949-364-1833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number54077
License Number StateCA

VIII. Authorized Official

Name: ROBERT MCDOUGALL
Title or Position: PRESIDENT
Credential:
Phone: 818-906-5721