Provider Demographics
NPI:1245781848
Name:GOERTZEN, JANICE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:GOERTZEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1374 NIGHTSHADE RD
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-3500
Mailing Address - Country:US
Mailing Address - Phone:559-917-2212
Mailing Address - Fax:
Practice Address - Street 1:1374 NIGHTSHADE RD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-3500
Practice Address - Country:US
Practice Address - Phone:559-917-2212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36623183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist