Healthcare Provider Details

I. General information

NPI: 1801967856
Provider Name (Legal Business Name): PHILIP MICHAEL GEBROE PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20056 VENTURA BL
WOODLAND HILLS CA
91364
US

IV. Provider business mailing address

22758 CARSAMBA DR
CALABASAS CA
91302-1801
US

V. Phone/Fax

Practice location:
  • Phone: 818-348-0860
  • Fax: 818-884-3290
Mailing address:
  • Phone: 818-348-0860
  • Fax: 818-222-2886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25184
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: