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General NPI Number Information
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NPI Number | 1669045654
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Entity Type | Individual
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Provider Name | STEPHEN ANTHONY GEBBIA II PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 15350 W BLUEMOUND RD
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City | ELM GROVE
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State | WI
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Zip | 53122-2307
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Country | US
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Telephone | 262-789-6819
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Fax |
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Provider Business Mailing Address
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Address Line | 12035 W BLACK OAK DR
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City | GREENFIELD
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State | WI
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Zip | 53228-1043
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Country | US
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Telephone | 414-477-8817
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 20977-40
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License Number State | WI
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