Healthcare Provider Details

I. General information

NPI: 1356348973
Provider Name (Legal Business Name): KRISTIN R GERICKE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W LA VETA AVE CALOPTIMA
ORANGE CA
92868-4231
US

IV. Provider business mailing address

1120 W LA VETA AVE CALOPTIMA
ORANGE CA
92868-4231
US

V. Phone/Fax

Practice location:
  • Phone: 714-246-8460
  • Fax: 714-481-6411
Mailing address:
  • Phone: 714-246-8460
  • Fax: 714-481-6411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42772
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: