Provider Demographics
NPI:1750706255
Name:NODALO, GIZELLE (RPH)
Entity type:Individual
Prefix:MRS
First Name:GIZELLE
Middle Name:
Last Name:NODALO
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 1:3638 S CINDY CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-5102
Mailing Address - Country:US
Mailing Address - Phone:818-913-5978
Mailing Address - Fax:
Practice Address - Street 1:1407 N DINUBA BLVD
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-2910
Practice Address - Country:US
Practice Address - Phone:559-734-2620
Practice Address - Fax:559-734-2259
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist