Provider Demographics
NPI:1467546861
Name:GEMMEL PHARMACY OF CHINO
Entity Type:Organization
Organization Name:GEMMEL PHARMACY OF CHINO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF PHCY OPS
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCORSATTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-984-7132
Mailing Address - Street 1:12163 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12163 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2421
Practice Address - Country:US
Practice Address - Phone:909-627-1581
Practice Address - Fax:909-627-9754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY40733333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0506343OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CAPHA407330Medicaid
0506343OtherOTHER ID NUMBER-COMMERCIAL NUMBER