Healthcare Provider Details

I. General information

NPI: 1407279755
Provider Name (Legal Business Name): RANDEE RENEE GELATIC PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 N 4TH ST
FLAGSTAFF AZ
86004-1816
US

IV. Provider business mailing address

2920 N 4TH ST
FLAGSTAFF AZ
86004-1816
US

V. Phone/Fax

Practice location:
  • Phone: 928-522-9468
  • Fax:
Mailing address:
  • Phone: 928-522-9468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19840
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3646
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: