Healthcare Provider Details

I. General information

NPI: 1104192574
Provider Name (Legal Business Name): MR. GILBERT KOAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8225 E GARVEY AVE
ROSEMEAD CA
91770
US

IV. Provider business mailing address

8225 GARVEY AVE
ROSEMEAD CA
91770-2551
US

V. Phone/Fax

Practice location:
  • Phone: 626-573-2017
  • Fax: 626-573-4529
Mailing address:
  • Phone: 626-573-2017
  • Fax: 626-573-4529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH36207
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: