Provider Demographics
NPI:1124371307
Name:GERHARDT, DAVID EDGAR (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:EDGAR
Last Name:GERHARDT
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 1:5839 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-9010
Mailing Address - Country:US
Mailing Address - Phone:608-850-9027
Mailing Address - Fax:608-850-9027
Practice Address - Street 1:2101 W BROADWAY
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713-1638
Practice Address - Country:US
Practice Address - Phone:608-222-2066
Practice Address - Fax:608-222-0578
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7688-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist