Healthcare Provider Details

I. General information

NPI: 1336137017
Provider Name (Legal Business Name): DAVID RUSSELL GUTEKUNST RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SHELLY RD
HARLEYSVILLE PA
19438-1281
US

IV. Provider business mailing address

2700 SHELLY RD
HARLEYSVILLE PA
19438-1201
US

V. Phone/Fax

Practice location:
  • Phone: 215-513-3053
  • Fax: 215-513-3052
Mailing address:
  • Phone: 215-513-3053
  • Fax: 215-513-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP031185L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA10002778
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: