MEDICARE: INLAND MEDICAL CONSULTANTS, LLC

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	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	52543	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2138237	OTHER		PK

General Provider Information

NPI Number	:	1831434331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INLAND MEDICAL CONSULTANTS, LLC

Provider Business Mailing Address
First Line	:	319 E PALM DR STE A
Second Line	:
City	:	PLACENTIA
State	:	CA
Zip	:	92870-3238
Country	:	US
Telephone Number	:	714-667-3832
Fax Number	:	888-978-5154

Provider Business Practice Location Address
First Line	:	319 E PALM DR STE A
Second Line	:
City	:	PLACENTIA
State	:	CA
Zip	:	92870-3238
Country	:	US
Telephone Number	:	714-667-3832
Fax Number	:	888-978-5154

Authorized Official
Title or Position	:	OWNER/AO
Name	:	GARY GILLMAN
Credential	:	B.A.
Telephone Number	:	951-858-5439

Provider Enumeration Date	:	12/10/2012
Last Update Date	:	07/19/2018

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