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NPI Code Detail

MEDICARE: MR. CHARLES MICHAEL GRAMLING R. PH.

MEDICARE:  MR. CHARLES MICHAEL GRAMLING  R. PH.
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
1183500000XPharmacist111875MN

General Provider Information

NPI Number : 1871621425
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHARLES MICHAEL GRAMLING R. PH.
Provider Business Mailing Address
First Line : 28854 LINDEN AVE
Second Line :
City : LINDSTROM
State : MN
Zip : 55045-9619
Country : US
Telephone Number : 651-257-3138
Fax Number :
Provider Business Practice Location Address
First Line : 10655 RAILROAD AVE
Second Line : PO BOX D
City : CHISAGO CITY
State : MN
Zip : 55013-9442
Country : US
Telephone Number : 651-257-4950
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2007
Last Update Date : 03/06/2008

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Directions to “ MR. CHARLES MICHAEL GRAMLING R. PH.” Practice Location

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