Provider Demographics
NPI:1558604389
Name:GILBERTSON, NICHOLAS (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:GILBERTSON
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15738 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2201
Mailing Address - Country:US
Mailing Address - Phone:262-781-6926
Mailing Address - Fax:262-781-0556
Practice Address - Street 1:15738 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2201
Practice Address - Country:US
Practice Address - Phone:262-781-6926
Practice Address - Fax:262-781-0556
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16677-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist