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General NPI Number Information
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NPI Number | 1962515767
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Entity Type | Organization
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Legal Business Name | GOMES ENTERPRISES
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 3101 SUNSET BLVD STE 2A
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City | ROCKLIN
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State | CA
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Zip | 95677-3097
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Country | US
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Telephone | 916-624-0570
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Fax | 916-624-0591
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Provider Business Mailing Address
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Address Line | 3101 SUNSET BLVD STE 2A
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City | ROCKLIN
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State | CA
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Zip | 95677-3097
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Country | US
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Telephone | 916-624-0570
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Fax | 916-624-0591
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Authorized Official
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Title or Position | OWNER CEO
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Name | MRS. CHANTELL LEE PETRALIA
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Credential | OWNER
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Telephone | 888-852-9373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY44817
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PHY44817
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License Number State | CA
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