Healthcare Provider Details

I. General information

NPI: 1588543748
Provider Name (Legal Business Name): CONRAD RAYMOND REN GASTFIELD PHARMD, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

956 CAMELOT DR
CRYSTAL LAKE IL
60014-8327
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-2090
  • Fax:
Mailing address:
  • Phone: 224-410-5427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.307338
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: