Provider Demographics
NPI:1093977894
Name:GULSETH, DANIEL RALPH (RPH)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:RALPH
Last Name:GULSETH
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 1:437 KROSHUS DR
Mailing Address - Street 2:
Mailing Address - City:DILWORTH
Mailing Address - State:MN
Mailing Address - Zip Code:56529-1636
Mailing Address - Country:US
Mailing Address - Phone:218-287-0690
Mailing Address - Fax:218-287-0690
Practice Address - Street 1:437 KROSHUS DR
Practice Address - Street 2:
Practice Address - City:DILWORTH
Practice Address - State:MN
Practice Address - Zip Code:56529-1636
Practice Address - Country:US
Practice Address - Phone:218-287-0690
Practice Address - Fax:218-287-0690
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND2817Medicaid