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General NPI Number Information
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NPI Number | 1679833024
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Entity Type | Individual
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Provider Name | GARY PETER METELAK RPH
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Gender | Male
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Dates
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Enumeration Date | 05/19/2012
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Last Update Date | 05/19/2012
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Provider Practice Location Address
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Address Line | 147 N BRENT ST
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City | VENTURA
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State | CA
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Zip | 93003-2809
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Country | US
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Telephone | 805-652-5068
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 FREMONTIA ST
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City | SANTA PAULA
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State | CA
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Zip | 93060-1212
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Country | US
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Telephone | 805-525-5884
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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 | 27734
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License Number State | CA
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