Provider Demographics
NPI:1053200048
Name:SAN GABRIEL PHARMACY INC
Entity type:Organization
Organization Name:SAN GABRIEL PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YANG
Authorized Official - Middle Name:
Authorized Official - Last Name:BAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-766-1779
Mailing Address - Street 1:828 E VALLEY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-4600
Mailing Address - Country:US
Mailing Address - Phone:626-766-1779
Mailing Address - Fax:
Practice Address - Street 1:828 E VALLEY BLVD STE B
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-4600
Practice Address - Country:US
Practice Address - Phone:626-766-1779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy