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General NPI Number Information
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NPI Number | 1881192508
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Entity Type | Individual
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Provider Name | RAIZA ANGELINE GANDOLA
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Gender | Female
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Dates
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Enumeration Date | 01/28/2018
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Last Update Date | 01/28/2018
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Provider Practice Location Address
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Address Line | 2000 VETERANS BLVD
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City | DUBLIN
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State | GA
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Zip | 31021-3030
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Country | US
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Telephone | 478-296-7608
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Fax |
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Provider Business Mailing Address
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Address Line | 2124 CHESHIRE BRIDGE RD NE APT 6104
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City | ATLANTA
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State | GA
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Zip | 30324-5725
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Country | US
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Telephone | 407-435-4093
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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 | RPH030316
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License Number State | GA
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