Healthcare Provider Details

I. General information

NPI: 1720309701
Provider Name (Legal Business Name): GARY M DRAGOVICH PHM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 WEST SEPULVEDA AVE.
TORRANCE CA
90501-5301
US

IV. Provider business mailing address

2240 WEST SEPULVEDA AVE
TORRANCE CA
90501-5301
US

V. Phone/Fax

Practice location:
  • Phone: 310-325-0868
  • Fax: 310-356-6486
Mailing address:
  • Phone: 310-325-0868
  • Fax: 310-356-6486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number35257
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: