Provider Demographics
NPI:1336803964
Name:GOMERAC, JOSEPH IAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:IAN
Last Name:GOMERAC
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 VILLAGE DR W APT G
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-3483
Mailing Address - Country:US
Mailing Address - Phone:618-971-7220
Mailing Address - Fax:
Practice Address - Street 1:1965 N STATE ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1089
Practice Address - Country:US
Practice Address - Phone:317-462-4241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26029538A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist