Provider Demographics
NPI:1134458227
Name:GOTTSCHLICH, RONALD PAUL (RPH)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:PAUL
Last Name:GOTTSCHLICH
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 1:12706 N 77TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-9093
Mailing Address - Country:US
Mailing Address - Phone:623-979-1228
Mailing Address - Fax:623-972-3249
Practice Address - Street 1:9245 W UNION HILLS DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-8154
Practice Address - Country:US
Practice Address - Phone:623-977-0903
Practice Address - Fax:623-972-3249
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0082891835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist