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General NPI Number Information
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NPI Number | 1316276660
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Entity Type | Individual
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Provider Name | GARY J KORTHALS RPH
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Gender | Male
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Dates
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Enumeration Date | 12/16/2009
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 201 S. WATER ST
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City | SPARTA
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State | WI
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Zip | 54656
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Country | US
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Telephone | 608-269-2949
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Fax | 608-269-3330
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Provider Business Mailing Address
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Address Line | 201 S. WATER ST
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City | SPARTA
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State | WI
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Zip | 54656
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Country | US
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Telephone | 608-269-2949
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Fax | 608-269-3330
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 10424
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 10424-40
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License Number State | WI
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