Provider Demographics
NPI:1790021996
Name:GERKE, GERALD D
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:D
Last Name:GERKE
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 1:80 NE CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-1956
Mailing Address - Country:US
Mailing Address - Phone:541-325-0466
Mailing Address - Fax:541-325-0468
Practice Address - Street 1:80 NE CEDAR ST
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-1956
Practice Address - Country:US
Practice Address - Phone:541-325-0466
Practice Address - Fax:541-325-0468
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4528183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist