Healthcare Provider Details

I. General information

NPI: 1477188415
Provider Name (Legal Business Name): NANCY GHATTAS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 FOREST PARK BLVD APT 342B
OXNARD CA
93036-5542
US

IV. Provider business mailing address

5021 VERDUGO WAY APT 342B
CAMARILLO CA
93012-8675
US

V. Phone/Fax

Practice location:
  • Phone: 805-223-3338
  • Fax:
Mailing address:
  • Phone: 805-223-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number47392
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number47392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: