Healthcare Provider Details

I. General information

NPI: 1689752198
Provider Name (Legal Business Name): GIL-JER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 COFFEE RD STE I
MODESTO CA
95355-2051
US

IV. Provider business mailing address

2400 COFFEE RD STE I
MODESTO CA
95355-2051
US

V. Phone/Fax

Practice location:
  • Phone: 209-522-1079
  • Fax: 209-575-0826
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY20203
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBORAH A DALTON
Title or Position: TECH
Credential:
Phone: 209-522-1079