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General NPI Number Information
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NPI Number | 1427786839
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Entity Type | Individual
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Provider Name | KENNETH JACOB GERHARDT JR. PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/12/2022
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Last Update Date | 08/12/2022
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Provider Practice Location Address
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Address Line | 1915 WISCONSIN AVE
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City | GRAFTON
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State | WI
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Zip | 53024-2605
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Country | US
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Telephone | 262-377-0352
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Fax |
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Provider Business Mailing Address
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Address Line | N7573 1090TH ST
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City | RIVER FALLS
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State | WI
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Zip | 54022-4914
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Country | US
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Telephone | 651-472-1330
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Fax |
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 361924025
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License Number State | WI
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