Provider Demographics
NPI:1174700660
Name:GEMMEL PHARMACY INC
Entity type:Organization
Organization Name:GEMMEL PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:YOON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:909-987-2518
Mailing Address - Street 1:3476 WHITTIER BLVD
Mailing Address - Street 2:107 108
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-1748
Mailing Address - Country:US
Mailing Address - Phone:323-262-8000
Mailing Address - Fax:323-262-8282
Practice Address - Street 1:3476 WHITTIER BLVD
Practice Address - Street 2:107 108
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-1748
Practice Address - Country:US
Practice Address - Phone:323-262-8000
Practice Address - Fax:323-262-8282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
CA498263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA85O1174700660Medicaid
5629247OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CA1174700660Medicaid
5629247OtherNCPDP PROVIDER IDENTIFICATION NUMBER