Provider Demographics
NPI:1801967856
Name:GEBROE, PHILIP MICHAEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:MICHAEL
Last Name:GEBROE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22758 CARSAMBA DR
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1801
Mailing Address - Country:US
Mailing Address - Phone:818-348-0860
Mailing Address - Fax:818-222-2886
Practice Address - Street 1:20056 VENTURA BL
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364
Practice Address - Country:US
Practice Address - Phone:818-348-0860
Practice Address - Fax:818-884-3290
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA449600Medicaid