Provider Demographics
NPI:1558954750
Name:GOETTSCH, NANETTE E (RPH)
Entity Type:Individual
Prefix:
First Name:NANETTE
Middle Name:E
Last Name:GOETTSCH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 BLUE VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2640
Mailing Address - Country:US
Mailing Address - Phone:913-217-2050
Mailing Address - Fax:
Practice Address - Street 1:12221 BLUE VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2640
Practice Address - Country:US
Practice Address - Phone:913-217-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-12301183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist