Healthcare Provider Details

I. General information

NPI: 1700319274
Provider Name (Legal Business Name): GELSON'S MARKETS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 VAN NUYS BLVD
SHERMAN OAKS CA
91403-2913
US

IV. Provider business mailing address

PO BOX 512256
LOS ANGELES CA
90051-0256
US

V. Phone/Fax

Practice location:
  • Phone: 818-377-4140
  • Fax: 818-377-4140
Mailing address:
  • Phone: 310-761-4511
  • Fax: 310-634-0998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number55489
License Number StateCA

VIII. Authorized Official

Name: STEWART EDINGTON
Title or Position: SENIOR DIRECTOR OF PHARMACY
Credential:
Phone: 310-761-4510