Provider Demographics
NPI:1023227311
Name:GARGANTOS, ARNOLD D (PHARMD)
Entity type:Individual
Prefix:
First Name:ARNOLD
Middle Name:D
Last Name:GARGANTOS
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 1:49 EASTFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90274-5259
Mailing Address - Country:US
Mailing Address - Phone:310-370-1040
Mailing Address - Fax:310-542-6411
Practice Address - Street 1:3586 REDONDO BEACH BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-1404
Practice Address - Country:US
Practice Address - Phone:310-370-1040
Practice Address - Fax:310-542-6411
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA43604OtherREGISTERED PHARMACIST LIC