Provider Demographics
NPI:1265461206
Name:GELSONS MARKETS
Entity Type:Organization
Organization Name:GELSONS MARKETS
Other - Org Name:GELSON'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDOUGALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-906-5721
Mailing Address - Street 1:25636 CROWN VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0464
Mailing Address - Country:US
Mailing Address - Phone:949-364-1914
Mailing Address - Fax:949-364-1833
Practice Address - Street 1:25636 CROWN VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-0464
Practice Address - Country:US
Practice Address - Phone:949-364-1914
Practice Address - Fax:949-364-1833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA540773336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155566OtherPK
CAPHA466940Medicaid
CA1115530200Medicare NSC
CAPHC021Medicare PIN
5613218OtherOTHER ID NUMBER-COMMERCIAL NUMBER