Provider Demographics
NPI:1205112810
Name:KRUEGER, GARY LEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEE
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27220 SUN CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2566
Mailing Address - Country:US
Mailing Address - Phone:951-679-8889
Mailing Address - Fax:951-679-5997
Practice Address - Street 1:27220 SUN CITY BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-2566
Practice Address - Country:US
Practice Address - Phone:951-679-8889
Practice Address - Fax:951-679-5997
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24657183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist