Provider Demographics
NPI:1134414022
Name:GOTHE, AMIEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMIEE
Middle Name:
Last Name:GOTHE
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 1:27320 W LUGONIA AVE
Mailing Address - Street 2:T-1869
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2041
Mailing Address - Country:US
Mailing Address - Phone:909-307-1810
Mailing Address - Fax:
Practice Address - Street 1:27320 W LUGONIA AVE
Practice Address - Street 2:T-1869
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2041
Practice Address - Country:US
Practice Address - Phone:909-307-1810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-18
Last Update Date:2011-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61739183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist