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General NPI Number Information
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NPI Number | 1790518058
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Entity Type | Individual
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Provider Name | ANABELLE VICTORIA GANTMAN PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 08/22/2024
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 1025 W 34TH ST STE 105
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City | LOS ANGELES
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State | CA
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Zip | 90089-0128
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Country | US
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Telephone | 213-821-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 603 S 5TH AVE UNIT C
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City | ARCADIA
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State | CA
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Zip | 91006-4091
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Country | US
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Telephone | 626-774-6261
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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 | 89849
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License Number State | CA
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