Provider Demographics
NPI:1982971099
Name:GAU, NANCY ILENE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ILENE
Last Name:GAU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:ILENE
Other - Last Name:GAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHAMD
Mailing Address - Street 1:4816 CEDARBROOK DR
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-2588
Mailing Address - Country:US
Mailing Address - Phone:712-249-3213
Mailing Address - Fax:
Practice Address - Street 1:2508 W BROADWAY
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-3509
Practice Address - Country:US
Practice Address - Phone:712-328-2266
Practice Address - Fax:712-328-9063
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19782183500000X
NE11759183500000X, 1835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N0905XPharmacy Service ProvidersPharmacistNuclear