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General NPI Number Information
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NPI Number | 1770045809
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Entity Type | Individual
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Provider Name | AMY SUSAN GADACZ PHARMD
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Gender | Female
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Dates
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Enumeration Date | 04/06/2019
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Last Update Date | 04/06/2019
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Provider Practice Location Address
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Address Line | 2200 N HARBOR BLVD
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City | FULLERTON
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State | CA
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Zip | 92835-2605
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Country | US
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Telephone | 714-446-9421
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Fax | 714-992-5052
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Provider Business Mailing Address
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Address Line | 1447 W HOUSTON AVE
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City | FULLERTON
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State | CA
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Zip | 92833-4605
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Country | US
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Telephone | 714-350-9841
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 55830
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License Number State | CA
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