Provider Demographics
NPI:1417009226
Name:GAUL, BRIAN L (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:GAUL
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 1:701 E CLIFTON ST
Mailing Address - Street 2:
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-2633
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 E CLIFTON ST
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-2633
Practice Address - Country:US
Practice Address - Phone:608-372-4115
Practice Address - Fax:608-372-9626
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19600183500000X
WI16983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist