Healthcare Provider Details

I. General information

NPI: 1760555395
Provider Name (Legal Business Name): GNN CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 ARMY DR STE A
DEDEDO GU
96929-6577
US

IV. Provider business mailing address

PO BOX 8682
TAMUNING GU
96931-8682
US

V. Phone/Fax

Practice location:
  • Phone: 671-637-1473
  • Fax: 671-637-1475
Mailing address:
  • Phone: 671-637-1473
  • Fax: 671-637-1475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPCY008
License Number StateGU

VIII. Authorized Official

Name: ADELA CARLOS
Title or Position: PHARMACIST-ON-DUTY
Credential: B.S. PHARMACY
Phone: 671-637-1473