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NPI Code Detail

MEDICARE: KAYE MARIE GORNALL RPH

MEDICARE:   KAYE MARIE GORNALL  RPH
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
1183500000XPharmacist30710CA

General Provider Information

NPI Number : 1538359245
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAYE MARIE GORNALL RPH
Provider Business Mailing Address
First Line : 10569 W PICO BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90064-2333
Country : US
Telephone Number : 310-475-3541
Fax Number :
Provider Business Practice Location Address
First Line : 10569 W PICO BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90064-2333
Country : US
Telephone Number : 310-475-3541
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2007
Last Update Date : 07/29/2007

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Directions to “ KAYE MARIE GORNALL RPH” Practice Location

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