Provider Demographics
NPI:1114188521
Name:GUTSCHOW, OLAF (RPH)
Entity Type:Individual
Prefix:MR
First Name:OLAF
Middle Name:
Last Name:GUTSCHOW
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3695 SAINTSBURY DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1043
Mailing Address - Country:US
Mailing Address - Phone:530-588-5149
Mailing Address - Fax:
Practice Address - Street 1:655 RUSSELL BLVD
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-3546
Practice Address - Country:US
Practice Address - Phone:530-756-3393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist