Provider Demographics
NPI:1073667473
Name:GOTTERER, HENRY A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:A
Last Name:GOTTERER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12071 MARQUIS CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-2947
Mailing Address - Country:US
Mailing Address - Phone:714-832-2887
Mailing Address - Fax:714-832-6197
Practice Address - Street 1:12665 GARDEN GROVE BLVD
Practice Address - Street 2:#108
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1901
Practice Address - Country:US
Practice Address - Phone:714-530-1130
Practice Address - Fax:714-537-7736
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist