Organization
OCOTILLO PHARMACY, INC.
Active
Other names
Brawley Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGORY GELMAN RPH (PRESIDENT/OWNER)
(760) 554-6940
Entity
Organization
Contact information
Practice address
196 W LEGION RD # B, BRAWLEY, CA 92227-7713
(760) 344-4100
(760) 344-9100
Mailing address
196 W LEGION RD # B, BRAWLEY, CA 92227-7713
(760) 344-4100
(760) 344-9100
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PHA465320
CA
332BX2000X
Oxygen Equipment & Supplies (DME)
PHA46520
CA
3336C0003X
Community/Retail Pharmacy
Primary
PHY46532
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5627609
NCPDP
CA
05
—
PHA465320
—
CA
Enumeration date
10/02/2006
Last updated
02/25/2013
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