Healthcare Provider Details

I. General information

NPI: 1649364043
Provider Name (Legal Business Name): GEMMEL PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 W FOOTHILL BLVD
UPLAND CA
91786-3727
US

IV. Provider business mailing address

823 W FOOTHILL BLVD
UPLAND CA
91786-3727
US

V. Phone/Fax

Practice location:
  • Phone: 909-985-2745
  • Fax: 909-985-7435
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY48869
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY48869
License Number StateCA

VIII. Authorized Official

Name: ALLEN SCORSATTO
Title or Position: DIR OF PHCY OPS
Credential:
Phone: 909-984-7132