Provider Demographics
NPI:1770045809
Name:GADACZ, AMY SUSAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:SUSAN
Last Name:GADACZ
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 1:1447 W HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-4605
Mailing Address - Country:US
Mailing Address - Phone:714-350-9841
Mailing Address - Fax:
Practice Address - Street 1:2200 N HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2605
Practice Address - Country:US
Practice Address - Phone:714-446-9421
Practice Address - Fax:714-992-5052
Is Sole Proprietor?:No
Enumeration Date:2019-04-06
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55830183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55830OtherPHARMACIST LICENSE