Provider Demographics
NPI:1649713900
Name:GOTTSTEIN, DONITA JAYNE
Entity type:Individual
Prefix:MRS
First Name:DONITA
Middle Name:JAYNE
Last Name:GOTTSTEIN
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 1:3300 IOWA ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-5206
Mailing Address - Country:US
Mailing Address - Phone:785-842-0177
Mailing Address - Fax:785-842-0178
Practice Address - Street 1:3300 IOWA ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-5206
Practice Address - Country:US
Practice Address - Phone:785-842-0177
Practice Address - Fax:785-842-0178
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12463183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist