Healthcare Provider Details

I. General information

NPI: 1871883934
Provider Name (Legal Business Name): KERRIE GOSTANIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5212 W WALNUT AVE
VISALIA CA
93277-3475
US

IV. Provider business mailing address

5212 W WALNUT AVE
VISALIA CA
93277
US

V. Phone/Fax

Practice location:
  • Phone: 559-733-5404
  • Fax:
Mailing address:
  • Phone: 559-739-8458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH46283
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: