MEDICARE: MR. DAVID RUSSELL GUTEKUNST RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP031185L	PA
2	183500000X	Pharmacist	A10002778	DE

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	4415720002	OTHER	PA	MEDICARE NSC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	PP481624	OTHER	PA	PA PERMIT
3	3986962	OTHER		NCPDP
4	4415720002	OTHER	PA	NSC
5	1558469486	OTHER		NPI

General Provider Information

NPI Number	:	1336137017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID RUSSELL GUTEKUNST RPH

Provider Business Mailing Address
First Line	:	2700 SHELLY RD
Second Line	:
City	:	HARLEYSVILLE
State	:	PA
Zip	:	19438-1201
Country	:	US
Telephone Number	:	215-513-3053
Fax Number	:	215-513-3052

Provider Business Practice Location Address
First Line	:	2700 SHELLY RD
Second Line	:
City	:	HARLEYSVILLE
State	:	PA
Zip	:	19438-1281
Country	:	US
Telephone Number	:	215-513-3053
Fax Number	:	215-513-3052

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	03/07/2023

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Directions to “ MR. DAVID RUSSELL GUTEKUNST RPH” Practice Location

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