Healthcare Provider Details

I. General information

NPI: 1396200580
Provider Name (Legal Business Name): JOANNA GUSTAS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 11/02/2022
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 KIMBALL AVE
WATERLOO IA
50702-5014
US

IV. Provider business mailing address

1900 18TH ST
DENVER CO
80202-6316
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-2112
  • Fax:
Mailing address:
  • Phone: 303-534-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number23341
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: