Provider Demographics
NPI:1598759052
Name:GAU, SANDRA JO
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:JO
Last Name:GAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 HIGHWAY 44 RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:IA
Mailing Address - Zip Code:51565-3009
Mailing Address - Country:US
Mailing Address - Phone:714-614-8417
Mailing Address - Fax:
Practice Address - Street 1:601 N 30TH ST
Practice Address - Street 2:SUITE 2807
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2137
Practice Address - Country:US
Practice Address - Phone:402-449-4560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist