Healthcare Provider Details

I. General information

NPI: 1598241705
Provider Name (Legal Business Name): RICHARD JOSEPH GELZLEICHTER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11109 PARKVIEW PLAZA DR
FORT WAYNE IN
46845-1701
US

IV. Provider business mailing address

724 CANDLELITE CT
FORT WAYNE IN
46807-3606
US

V. Phone/Fax

Practice location:
  • Phone: 260-266-4400
  • Fax:
Mailing address:
  • Phone: 260-456-5778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26019543A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: