MEDICARE: GABRIEL DENZEL PAULSEN PHARMD

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	5302416207	MI

General Provider Information

NPI Number	:	1548196405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL DENZEL PAULSEN PHARMD

Provider Business Mailing Address
First Line	:	103 ARLO ST
Second Line	:
City	:	BOYNE CITY
State	:	MI
Zip	:	49712-8918
Country	:	US
Telephone Number	:	231-838-5011
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 N LAKE ST
Second Line	:
City	:	BOYNE CITY
State	:	MI
Zip	:	49712-1104
Country	:	US
Telephone Number	:	231-582-2101
Fax Number	:

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

Provider Enumeration Date	:	06/19/2026
Last Update Date	:	06/19/2026

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