Provider Demographics
NPI:1457637738
Name:GEHRING, WALLACE L (RPH)
Entity Type:Individual
Prefix:MR
First Name:WALLACE
Middle Name:L
Last Name:GEHRING
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:W3396 DUCK CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:MONTELLO
Mailing Address - State:WI
Mailing Address - Zip Code:53949-8431
Mailing Address - Country:US
Mailing Address - Phone:920-293-8787
Mailing Address - Fax:
Practice Address - Street 1:3200 8TH ST S
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-6563
Practice Address - Country:US
Practice Address - Phone:715-424-4082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8450-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist