Provider Demographics
NPI:1083996193
Name:GUNGLER, JOSEPH MMICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MMICHAEL
Last Name:GUNGLER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7324 WATERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-1285
Mailing Address - Country:US
Mailing Address - Phone:719-574-4587
Mailing Address - Fax:
Practice Address - Street 1:7324 WATERMAN WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-1285
Practice Address - Country:US
Practice Address - Phone:719-574-4587
Practice Address - Fax:719-598-3918
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist