Provider Demographics
NPI:1356775993
Name:GERGES, PAUL ISAAC (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ISAAC
Last Name:GERGES
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 1:16820 BLACKHAWK ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-7301
Mailing Address - Country:US
Mailing Address - Phone:818-618-2355
Mailing Address - Fax:
Practice Address - Street 1:10120 MASON AVE
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-3301
Practice Address - Country:US
Practice Address - Phone:818-349-7213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-31
Last Update Date:2013-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist