MEDICARE: MR. DONALD CHARLES GITERSONKE RPH, MBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	20405	MI
2	183500000X	Pharmacist	12226	NV

General Provider Information

NPI Number	:	1013133784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD CHARLES GITERSONKE RPH, MBA

Provider Business Mailing Address
First Line	:	9333 MOUNT CHERIE AVE
Second Line	:	# 101
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7566
Country	:	US
Telephone Number	:	702-256-0833
Fax Number	:

Provider Business Practice Location Address
First Line	:	9333 MOUNT CHERIE AVE
Second Line	:	# 101
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7566
Country	:	US
Telephone Number	:	702-256-0833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	07/08/2007

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