Provider Demographics
NPI:1093056343
Name:GETTEL, GERALD WALTER (RPH)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:WALTER
Last Name:GETTEL
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 1:219 PAUL BUNYAN DR NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-2433
Mailing Address - Country:US
Mailing Address - Phone:218-444-5228
Mailing Address - Fax:218-444-2451
Practice Address - Street 1:219 PAUL BUNYAN DR NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-2433
Practice Address - Country:US
Practice Address - Phone:218-444-5228
Practice Address - Fax:218-444-2451
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist