Healthcare Provider Details

I. General information

NPI: 1164718870
Provider Name (Legal Business Name): PIERRE GABRYEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 LOS OSOS VALLEY RD
LOS OSOS CA
93402-3204
US

IV. Provider business mailing address

1541 EL TIGRE CT APT 7
SAN LUIS OBISPO CA
93405-6442
US

V. Phone/Fax

Practice location:
  • Phone: 805-528-5779
  • Fax:
Mailing address:
  • Phone: 805-704-4740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number59278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: