Provider Demographics
NPI:1326094798
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:PRES
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 1:1736 E AVENIDA DE LOS ARBOLES
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-1301
Mailing Address - Country:US
Mailing Address - Phone:805-493-8001
Mailing Address - Fax:805-493-5490
Practice Address - Street 1:1736 E AVENIDA DE LOS ARBOLES
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-1301
Practice Address - Country:US
Practice Address - Phone:805-493-8001
Practice Address - Fax:805-493-5490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA540013336C0003X
333600000X
CAPHY513133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155567OtherPK
2004395OtherPK
CA071PHA477470Medicaid
CA4H0PHA303080Medicaid