Healthcare Provider Details

I. General information

NPI: 1992695449
Provider Name (Legal Business Name): NIKOLET GORGIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SENECA ST STE 602
BUFFALO NY
14210-1351
US

IV. Provider business mailing address

944 DANCER WAY
TURLOCK CA
95382-8311
US

V. Phone/Fax

Practice location:
  • Phone: 716-541-0273
  • Fax:
Mailing address:
  • Phone: 209-485-0607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH88516
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: