Provider Demographics
NPI:1851761274
Name:GOTT, NANCY ELIZABETH (RPH)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ELIZABETH
Last Name:GOTT
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 1:2403 E PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-5101
Mailing Address - Country:US
Mailing Address - Phone:619-267-8882
Mailing Address - Fax:619-267-0985
Practice Address - Street 1:2403 E PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-5101
Practice Address - Country:US
Practice Address - Phone:619-267-8882
Practice Address - Fax:619-267-0985
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA35101OtherRX LICENSE