Provider Demographics
NPI:1477188415
Name:GHATTAS, NANCY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:GHATTAS
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 1:5021 VERDUGO WAY APT 342B
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8675
Mailing Address - Country:US
Mailing Address - Phone:805-223-3338
Mailing Address - Fax:
Practice Address - Street 1:550 FOREST PARK BLVD APT 342B
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-5542
Practice Address - Country:US
Practice Address - Phone:805-223-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA473921835C0205X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No1835C0205XPharmacy Service ProvidersPharmacistCritical CareGroup - Single Specialty