Provider Demographics
NPI:1457845596
Name:GELAN, GIBE GENETI
Entity Type:Individual
Prefix:
First Name:GIBE
Middle Name:GENETI
Last Name:GELAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E MCCOY LN UNIT 9B
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-1387
Mailing Address - Country:US
Mailing Address - Phone:808-854-6422
Mailing Address - Fax:
Practice Address - Street 1:310 E MCCOY LN UNIT 9B
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1387
Practice Address - Country:US
Practice Address - Phone:808-854-6422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist