MEDICARE: GRETCHEN KUNZE PHARM.D.

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	15341040	WI
2	183500000X	Pharmacist	18198	CO

General Provider Information

NPI Number	:	1710211107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN KUNZE PHARM.D.

Provider Business Mailing Address
First Line	:	1225 7TH ST S
Second Line	:	#305
City	:	LA CROSSE
State	:	WI
Zip	:	54601-5405
Country	:	US
Telephone Number	:	720-352-8015
Fax Number	:

Provider Business Practice Location Address
First Line	:	2442 STATE RD
Second Line	:
City	:	LA CROSSE
State	:	WI
Zip	:	54601-6155
Country	:	US
Telephone Number	:	608-775-8877
Fax Number	:

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

Provider Enumeration Date	:	10/01/2009
Last Update Date	:	10/01/2009

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