Organization
DESERT AGAVE PHARMACY INC
Active
Organization
DESERT AGAVE PHARMACY INC
Active
Other names
DE ANZA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY GELMAN PHARM D (PRESIDENT/PIC)
(760) 768-2900
Entity
Organization
Contact information
Practice address
302 #B E 3RD ST, CALEXICO, CA 92231-2760
(760) 768-2900
(760) 768-2929
Mailing address
302 #B E 3RD ST, CALEXICO, CA 92231-2760
(760) 768-2900
(760) 768-2929
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PHY50893
CA
3336C0003X
Community/Retail Pharmacy
Primary
PHY50893
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHY50893
CALIFORNIA STATE BOARD OF PHARMACY
CA
Enumeration date
03/29/2012
Last updated
03/07/2023
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