Provider Demographics
NPI:1326259466
Name:SAUER, GORDON (RPH, MS, FASCP)
Entity Type:Individual
Prefix:MR
First Name:GORDON
Middle Name:
Last Name:SAUER
Suffix:
Gender:M
Credentials:RPH, MS, FASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W353N6026 BAYSHORE CIR
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-1820
Mailing Address - Country:US
Mailing Address - Phone:414-550-5821
Mailing Address - Fax:262-567-0097
Practice Address - Street 1:W353N6026 BAYSHORE CIR
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-1820
Practice Address - Country:US
Practice Address - Phone:414-550-5821
Practice Address - Fax:262-567-0097
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIR81381835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric