Provider Demographics
NPI:1215065487
Name:GOETSCH, DONALD W (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:W
Last Name:GOETSCH
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2625
Mailing Address - Street 2:1105 MICHIGAN AVE
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-2625
Mailing Address - Country:US
Mailing Address - Phone:208-476-3569
Mailing Address - Fax:
Practice Address - Street 1:1105 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-2625
Practice Address - Country:US
Practice Address - Phone:208-476-5727
Practice Address - Fax:208-476-4045
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP3809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist