MEDICARE: DR. SANDRA JO GAU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	10550	NE

General Provider Information

NPI Number	:	1598759052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA JO GAU

Provider Business Mailing Address
First Line	:	215 HIGHWAY 44 RD
Second Line	:
City	:	PORTSMOUTH
State	:	IA
Zip	:	51565-3009
Country	:	US
Telephone Number	:	714-614-8417
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 N 30TH ST
Second Line	:	SUITE 2807
City	:	OMAHA
State	:	NE
Zip	:	68131-2137
Country	:	US
Telephone Number	:	402-449-4560
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	06/26/2020

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