Organization
OCOTILLO PHARMACY
Active
Other names
farmacia del valle
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY GELMAN (PRESIDENT/PIC)
(760) 353-2500
Entity
Organization
Contact information
Practice address
1745 S IMPERIAL AVE STE 112, EL CENTRO, CA 92243-4243
(760) 353-2500
(760) 353-0037
Mailing address
1745 S IMPERIAL AVE STE 112, EL CENTRO, CA 92243-4243
(760) 353-2500
(760) 353-0037
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
50512
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5639894
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHY50512
—
CA
Enumeration date
01/17/2011
Last updated
09/08/2011
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