Provider Demographics
NPI:1831414028
Name:GOTTSCHALK, IRENE ISABEL (RPH)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:ISABEL
Last Name:GOTTSCHALK
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 1:909 17TH ST
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2379
Mailing Address - Country:US
Mailing Address - Phone:360-299-2816
Mailing Address - Fax:360-299-8565
Practice Address - Street 1:909 17TH ST
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2379
Practice Address - Country:US
Practice Address - Phone:360-299-2816
Practice Address - Fax:360-299-8565
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60123576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist