Healthcare Provider Details

I. General information

NPI: 1750038410
Provider Name (Legal Business Name): MARIE ANN GEHRKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 CABARRUS AVE W
CONCORD NC
28027-6850
US

IV. Provider business mailing address

608 WAYFORTH RD NW
CONCORD NC
28027-3650
US

V. Phone/Fax

Practice location:
  • Phone: 704-723-9463
  • Fax:
Mailing address:
  • Phone: 816-868-7179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number31005
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: