Provider Demographics
NPI:1770016271
Name:SPERL, GARY ALAN
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ALAN
Last Name:SPERL
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 1:1101 2ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-2943
Mailing Address - Country:US
Mailing Address - Phone:320-632-2380
Mailing Address - Fax:320-632-3079
Practice Address - Street 1:1101 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345
Practice Address - Country:US
Practice Address - Phone:320-632-2380
Practice Address - Fax:320-630-3079
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN112878OtherPROVIDER