Provider Demographics
NPI:1255470738
Name:EISENBEIS, GERALD ROBERT II (RPH)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:ROBERT
Last Name:EISENBEIS
Suffix:II
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 1:1129 DEER CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-9263
Mailing Address - Country:US
Mailing Address - Phone:810-655-2583
Mailing Address - Fax:
Practice Address - Street 1:G3320 BEECHER RD
Practice Address - Street 2:DIPLOMAT SPECIALTY PHARMACY
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532
Practice Address - Country:US
Practice Address - Phone:810-732-8720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030502183500000X
FLPS39914183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist