Organization
GAVIN HERBERT COMPANY
Active
Other names
HORTON AND CONVERSE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS MEDICI (CONTROLLER)
(949) 640-1231
Entity
Organization
Contact information
Practice address
201 S ALVARADO ST, STE 611, LOS ANGELES, CA 90057-2320
(213) 413-2424
(213) 413-2427
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
—
—
333600000X
Pharmacy
Primary
PHY20283
CA
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0566971
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
PHA202830
—
CA
Enumeration date
11/08/2006
Last updated
01/12/2011
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