Provider Demographics
NPI:1528361045
Name:GRUBER, CHRISTINE M (RPH)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:GRUBER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4647 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1255
Mailing Address - Country:US
Mailing Address - Phone:414-276-4128
Mailing Address - Fax:
Practice Address - Street 1:4647 N LAKE DR
Practice Address - Street 2:
Practice Address - City:WHITEFISH BAY
Practice Address - State:WI
Practice Address - Zip Code:53211-1255
Practice Address - Country:US
Practice Address - Phone:414-276-4128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12324-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist