Provider Demographics
NPI:1013012996
Name:GANSE, GERALD E
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:E
Last Name:GANSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 BEACONFIELD LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5343
Mailing Address - Country:US
Mailing Address - Phone:717-577-2735
Mailing Address - Fax:
Practice Address - Street 1:355 W KING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3751
Practice Address - Country:US
Practice Address - Phone:717-394-5671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP027278L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP027278LOtherSTATE LICENSE