Provider Demographics
NPI:1790518058
Name:GANTMAN, ANABELLE VICTORIA (PHARMD)
Entity type:Individual
Prefix:
First Name:ANABELLE
Middle Name:VICTORIA
Last Name:GANTMAN
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 1:603 S 5TH AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-4091
Mailing Address - Country:US
Mailing Address - Phone:626-774-6261
Mailing Address - Fax:
Practice Address - Street 1:1025 W 34TH ST STE 105
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0128
Practice Address - Country:US
Practice Address - Phone:213-821-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist