Healthcare Provider Details

I. General information

NPI: 1326094798
Provider Name (Legal Business Name): GELSONS MARKETS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1736 E AVENIDA DE LOS ARBOLES
THOUSAND OAKS CA
91362-1301
US

IV. Provider business mailing address

1736 E AVENIDA DE LOS ARBOLES
THOUSAND OAKS CA
91362-1301
US

V. Phone/Fax

Practice location:
  • Phone: 805-493-8001
  • Fax: 805-493-5490
Mailing address:
  • Phone: 805-493-8001
  • Fax: 805-493-5490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number54001
License Number StateCA

VIII. Authorized Official

Name: ROBERT MCDOUGALL
Title or Position: PRES
Credential:
Phone: 818-906-5721