Provider Demographics
NPI:1508878539
Name:GERLACH, RICKI JOSEPH (CPHT)
Entity Type:Individual
Prefix:MR
First Name:RICKI
Middle Name:JOSEPH
Last Name:GERLACH
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16426 MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1128
Mailing Address - Country:US
Mailing Address - Phone:586-306-7198
Mailing Address - Fax:313-576-1105
Practice Address - Street 1:4646 JOHN R ST
Practice Address - Street 2:OUTPATIENT PHARMACY 118CP
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1916
Practice Address - Country:US
Practice Address - Phone:313-576-4616
Practice Address - Fax:313-576-1105
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1401-0452-0763-960183700000X
136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered