Healthcare Provider Details

I. General information

NPI: 1831434331
Provider Name (Legal Business Name): INLAND MEDICAL CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 E PALM DR STE A
PLACENTIA CA
92870-3238
US

IV. Provider business mailing address

319 E PALM DR STE A
PLACENTIA CA
92870-3238
US

V. Phone/Fax

Practice location:
  • Phone: 714-667-3832
  • Fax: 888-978-5154
Mailing address:
  • Phone: 714-667-3832
  • Fax: 888-978-5154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number52543
License Number StateCA

VIII. Authorized Official

Name: GARY GILLMAN
Title or Position: OWNER/AO
Credential: B.A.
Phone: 951-858-5439