Provider Demographics
NPI:1770866352
Name:GERBER, THEODORE D (RPH)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:D
Last Name:GERBER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6S235 STEEPLE RUN DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-3769
Mailing Address - Country:US
Mailing Address - Phone:630-717-9333
Mailing Address - Fax:
Practice Address - Street 1:6S235 STEEPLE RUN DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-3769
Practice Address - Country:US
Practice Address - Phone:630-717-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.038319183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051.038319OtherILLINOIS RPH LICENSE