Provider Demographics
NPI:1710211107
Name:KUNZE, GRETCHEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:KUNZE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 7TH ST S
Mailing Address - Street 2:#305
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5405
Mailing Address - Country:US
Mailing Address - Phone:720-352-8015
Mailing Address - Fax:
Practice Address - Street 1:2442 STATE RD
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-6155
Practice Address - Country:US
Practice Address - Phone:608-775-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15341040183500000X
CO18198183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist