| Organization Name: | OCOTILLO PHARMACY, INC. |
| NPI Number: | 1487747002 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GREGORY GELMAN (PRESIDENT/OWNER) |
| Mailing Address: | 196 W Legion Rd # B Brawley |
| State: | CA US |
| Postal Code: | 922277713 |
| Phone Number: | 7603444100 |
| Fax Number: | 7603449100 |
| NPI Enumeration Date: | 10/02/2006 |
| NPI Last Update Date: | 02/25/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | PHA465320 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |