Provider Demographics
NPI:1942554530
Name:GAKS PHARMACY, LLC
Entity Type:Organization
Organization Name:GAKS PHARMACY, LLC
Other - Org Name:BALBOA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EUN
Authorized Official - Middle Name:JOO
Authorized Official - Last Name:GAK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:818-831-2090
Mailing Address - Street 1:10700 BALBOA BLVD # 101
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-5001
Mailing Address - Country:US
Mailing Address - Phone:818-831-2090
Mailing Address - Fax:
Practice Address - Street 1:10700 BALBOA BLVD # 101
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-5001
Practice Address - Country:US
Practice Address - Phone:818-831-2090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-03
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY511363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy