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General NPI Number Information
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NPI Number | 1548914575
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Entity Type | Individual
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Provider Name | GARY DAVID METELSKI
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Gender | Male
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Dates
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Enumeration Date | 02/08/2022
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Last Update Date | 09/22/2023
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Provider Practice Location Address
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Address Line | 401 E BIRCH ST STE D
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City | CALEXICO
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State | CA
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Zip | 92231-4526
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Country | US
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Telephone | 760-890-5977
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Fax |
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Provider Business Mailing Address
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Address Line | 1840 RODEO DR
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City | IMPERIAL
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State | CA
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Zip | 92251-9532
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Country | US
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Telephone | 760-234-9171
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PHY41305
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License Number State | CA
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