Healthcare Provider Details

I. General information

NPI: 1669045654
Provider Name (Legal Business Name): STEPHEN ANTHONY GEBBIA II PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15350 W BLUEMOUND RD
ELM GROVE WI
53122-2307
US

IV. Provider business mailing address

12035 W BLACK OAK DR
GREENFIELD WI
53228-1043
US

V. Phone/Fax

Practice location:
  • Phone: 262-789-6819
  • Fax:
Mailing address:
  • Phone: 414-477-8817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20977-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: