Provider Demographics
NPI:1922133123
Name:FLESHNER, GERALD H (RPH)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:H
Last Name:FLESHNER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:H
Other - Last Name:FLESHNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:LINCOLN HIGHWAY PHARMACY
Mailing Address - Street 2:859 E US HIGHWAY 30
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401
Mailing Address - Country:US
Mailing Address - Phone:712-775-6337
Mailing Address - Fax:712-792-2403
Practice Address - Street 1:859 E US HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-2617
Practice Address - Country:US
Practice Address - Phone:712-775-6337
Practice Address - Fax:712-792-2403
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist