Provider Demographics
NPI:1932659133
Name:GANOTISI, ERICSON C (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ERICSON
Middle Name:C
Last Name:GANOTISI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 ALAMO DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-5601
Mailing Address - Country:US
Mailing Address - Phone:707-359-3183
Mailing Address - Fax:707-359-3184
Practice Address - Street 1:941 ALAMO DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-5601
Practice Address - Country:US
Practice Address - Phone:707-359-3183
Practice Address - Fax:707-359-3184
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74303183500000X
HI3881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist