Provider Demographics
NPI:1316935364
Name:JOHN L SILBERSTEIN
Entity type:Organization
Organization Name:JOHN L SILBERSTEIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST - OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SILBERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:714-636-0593
Mailing Address - Street 1:12555 GARDEN GROVE BLVD
Mailing Address - Street 2:#102
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1902
Mailing Address - Country:US
Mailing Address - Phone:714-636-0593
Mailing Address - Fax:714-636-7708
Practice Address - Street 1:12555 GARDEN GROVE BLVD
Practice Address - Street 2:#102
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1902
Practice Address - Country:US
Practice Address - Phone:714-636-0593
Practice Address - Fax:714-636-7708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY30791183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0552984OtherNABP
CAPHA307910Medicaid
CA0203290001Medicare NSC