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General NPI Number Information
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NPI Number | 1720079221
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Entity Type | Individual
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Provider Name | DEAN MATTHEW GRUBER RPH
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Gender | Male
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 10/23/2012
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Provider Practice Location Address
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Address Line | 826 N PLANKINTON AVE STE 100
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City | MILWAUKEE
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State | WI
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Zip | 53203-1832
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Country | US
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Telephone | 866-746-3799
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Fax | 414-273-5986
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Provider Business Mailing Address
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Address Line | 4647 N LAKE DR
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City | WHITEFISH BAY
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State | WI
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Zip | 53211-1255
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Country | US
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Telephone | 414-276-4128
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Fax | 414-273-5986
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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 | 12973040
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License Number State | WI
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