Mark Sean Gannon, RPH
Individual provider Active NPI Pharmacist · Calipatria, CA
NPI 1023368784 · NPPES record last updated Sep 10, 2012
Key facts
- NPI
- 1023368784
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 50696 (CA)
- Practice address
- 7018 Blair Rd
Calipatria, CA 92233-9633 - Phone
- (760) 604-2224
- NPI assigned
- Sep 10, 2012
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50696 | CA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 50696 | CA | Yes |
Addresses
Primary practice location
7018 Blair Rd
Calipatria, CA 92233-9633
Mailing address
PO Box 517
Chula Vista, CA 91912-0517
Phone (858) 243-7343
Other providers in Calipatria, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.