Provider Demographics
NPI:1124359120
Name:GENTSCH, BILL (PHARMD)
Entity Type:Individual
Prefix:
First Name:BILL
Middle Name:
Last Name:GENTSCH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 E BROWN RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4001
Mailing Address - Country:US
Mailing Address - Phone:480-396-8193
Mailing Address - Fax:480-807-5495
Practice Address - Street 1:4420 E BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4001
Practice Address - Country:US
Practice Address - Phone:480-396-8193
Practice Address - Fax:480-807-5495
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist