MEDICARE: GJPL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	42814	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437146453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GJPL, INC.

Provider Business Mailing Address
First Line	:	1301 20TH ST
Second Line	:	SUITE #120
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-2050
Country	:	US
Telephone Number	:	310-453-6553
Fax Number	:	310-828-5645

Provider Business Practice Location Address
First Line	:	1301 20TH ST
Second Line	:	SUITE 120
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-2050
Country	:	US
Telephone Number	:	310-453-6553
Fax Number	:	310-828-5645

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MRS. FARNAZ MAHDAVI MAVADAT
Credential	:	RPH
Telephone Number	:	310-453-6553

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	08/22/2020

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Directions to “GJPL, INC. ” Practice Location

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