Healthcare Provider Details

I. General information

NPI: 1679092829
Provider Name (Legal Business Name): KATHLEEN GEHRELS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN PETERS

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 09/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 S GRANGE AVE
SIOUX FALLS SD
57105-6359
US

IV. Provider business mailing address

6500 W 26TH ST
SIOUX FALLS SD
57106-5327
US

V. Phone/Fax

Practice location:
  • Phone: 605-988-9150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR6478
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: