Provider Demographics
NPI:1891909909
Name:GILBERT MATHIEU
Entity Type:Organization
Organization Name:GILBERT MATHIEU
Other - Org Name:HANDLER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MATHIEU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:323-299-9812
Mailing Address - Street 1:4729 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90062-2321
Mailing Address - Country:US
Mailing Address - Phone:323-299-9812
Mailing Address - Fax:323-295-5481
Practice Address - Street 1:4729 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-2321
Practice Address - Country:US
Practice Address - Phone:323-299-9812
Practice Address - Fax:323-295-5481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY179473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA179470Medicaid
CAPHA179470Medicare ID - Type Unspecified