Healthcare Provider Details

I. General information

NPI: 1831680479
Provider Name (Legal Business Name): BRANDON LOREN GERLEMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 N 1ST AVE
WINTERSET IA
50273-1594
US

IV. Provider business mailing address

118 N 1ST AVE
WINTERSET IA
50273-1594
US

V. Phone/Fax

Practice location:
  • Phone: 515-462-2282
  • Fax: 515-462-2296
Mailing address:
  • Phone: 515-462-2282
  • Fax: 515-462-2296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number23035
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: