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General NPI Number Information
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NPI Number | 1942554530
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Entity Type | Organization
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Legal Business Name | GAKS PHARMACY, LLC
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Dates
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Enumeration Date | 11/03/2012
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Last Update Date | 04/23/2015
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Provider Practice Location Address
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Address Line | 10700 BALBOA BLVD # 101
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City | GRANADA HILLS
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State | CA
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Zip | 91344-5001
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Country | US
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Telephone | 818-831-2090
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Fax |
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Provider Business Mailing Address
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Address Line | 10700 BALBOA BLVD # 101
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City | GRANADA HILLS
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State | CA
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Zip | 91344-5001
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Country | US
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Telephone | 818-831-2090
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EUN JOO GAK
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Credential | PHARM.D.
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Telephone | 818-831-2090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY51136
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License Number State | CA
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