Provider Demographics
NPI:1265586697
Name:GULSTRAND, RUDOLPH ELMER JR (RPH MBA)
Entity type:Individual
Prefix:MR
First Name:RUDOLPH
Middle Name:ELMER
Last Name:GULSTRAND
Suffix:JR
Gender:M
Credentials:RPH MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2787 TONAWANDA DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116
Mailing Address - Country:US
Mailing Address - Phone:440-331-8859
Mailing Address - Fax:
Practice Address - Street 1:2787 TONAWANDA DRIVE
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116
Practice Address - Country:US
Practice Address - Phone:440-331-8859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03225133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist