Provider Demographics
NPI:1609762202
Name:GOUGER, BRIAN K
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:K
Last Name:GOUGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 WOLGEMUTH DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-6201
Mailing Address - Country:US
Mailing Address - Phone:717-201-8966
Mailing Address - Fax:
Practice Address - Street 1:208 WOLGEMUTH DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-6201
Practice Address - Country:US
Practice Address - Phone:717-201-8966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042753L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist