Healthcare Provider Details

I. General information

NPI: 1649547548
Provider Name (Legal Business Name): DANIEL GEHRAND RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2011
Last Update Date: 11/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25401 75TH ST
SALEM WI
53168-9527
US

IV. Provider business mailing address

25401 75TH ST
SALEM WI
53168-9527
US

V. Phone/Fax

Practice location:
  • Phone: 262-843-1550
  • Fax: 262-843-9449
Mailing address:
  • Phone: 262-843-1550
  • Fax: 262-843-9449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12698-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: