Healthcare Provider Details

I. General information

NPI: 1043570385
Provider Name (Legal Business Name): GBV CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E COLORADO BLVD
PASADENA CA
91101-2102
US

IV. Provider business mailing address

700 E COLORADO BLVD
PASADENA CA
91101-2102
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-7979
  • Fax: 626-577-7977
Mailing address:
  • Phone: 626-577-7979
  • Fax: 626-577-7977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number50930
License Number StateCA

VIII. Authorized Official

Name: GAYANE BESNELIAN
Title or Position: PRESIDENT/PIC
Credential:
Phone: 626-577-7979