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General NPI Number Information
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NPI Number | 1508878539
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Entity Type | Individual
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Provider Name | RICKI JOSEPH GERLACH CPHT
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Gender | Male
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 07/13/2007
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Provider Practice Location Address
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Address Line | 4646 JOHN R ST OUTPATIENT PHARMACY 118CP
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City | DETROIT
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State | MI
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Zip | 48201-1916
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Country | US
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Telephone | 313-576-4616
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Fax | 313-576-1105
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Provider Business Mailing Address
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Address Line | 16426 MANCHESTER AVE
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City | EASTPOINTE
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State | MI
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Zip | 48021-1128
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Country | US
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Telephone | 586-306-7198
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Fax | 313-576-1105
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 1401-0452-0763-960
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 136A00000X
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Taxonomy Name | Registered Dietetic Technician
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License Number |
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License Number State |
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