Provider Demographics
NPI:1598828618
Name:GOESER, ANGIE L (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:L
Last Name:GOESER
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 1:7917 KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-2135
Mailing Address - Country:US
Mailing Address - Phone:402-740-0704
Mailing Address - Fax:
Practice Address - Street 1:7909 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68112-2418
Practice Address - Country:US
Practice Address - Phone:402-280-3992
Practice Address - Fax:402-280-4785
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist