Provider Demographics
NPI:1558808147
Name:GERSHATER, MARK FRANKLIN (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:FRANKLIN
Last Name:GERSHATER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 N FM 620 RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-4539
Mailing Address - Country:US
Mailing Address - Phone:512-336-7706
Mailing Address - Fax:512-336-7734
Practice Address - Street 1:7301 N FM 620 RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726-4539
Practice Address - Country:US
Practice Address - Phone:512-336-7706
Practice Address - Fax:512-336-7734
Is Sole Proprietor?:No
Enumeration Date:2017-01-21
Last Update Date:2017-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21770183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist