Organization
GAVIN HERBERT CO.
Active
Other names
Horton & Converse Home Medical
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEITH ROBERT LUMPKIN (PRESIDENT)
(949) 640-1231
Entity
Organization
Contact information
Practice address
11600 WILSHIRE BLVD., LOS ANGELES, CA 90025-1773
(310) 479-0960
(310) 477-3509
Mailing address
PO BOX 9889, NEWPORT BEACH, CA 92658-1889
(949) 640-1231
(949) 640-9123
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1995613
PK
—
05
—
PHA165950
—
CA
Enumeration date
11/08/2006
Last updated
07/22/2019
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