Healthcare Provider Details

I. General information

NPI: 1104869296
Provider Name (Legal Business Name): MICHAEL C GERDES RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 03/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 GLENDALE AVE
EDISON NJ
08817-5279
US

IV. Provider business mailing address

16 JARED LN
MANALAPAN NJ
07726-3664
US

V. Phone/Fax

Practice location:
  • Phone: 888-319-1818
  • Fax: 877-290-1812
Mailing address:
  • Phone: 732-792-3926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02739500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: