Organization
GIL-JER, INC
Active
Other names
MODEL PHARMACY & Medical Dental Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBORAH A DALTON (TECH)
(209) 522-1079
Entity
Organization
Contact information
Practice address
2400 COFFEE RD, STE I, MODESTO, CA 95355-2051
(209) 522-1079
(209) 575-0826
Mailing address
2400 COFFEE RD, STE I, MODESTO, CA 95355-2051
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PHY20203
CA
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0538097
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
PHA202030
—
CA
Enumeration date
11/01/2006
Last updated
08/12/2008
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