Provider Demographics
NPI:1336137017
Name:GUTEKUNST, DAVID RUSSELL (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RUSSELL
Last Name:GUTEKUNST
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 1:2700 SHELLY RD
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-1201
Mailing Address - Country:US
Mailing Address - Phone:215-513-3053
Mailing Address - Fax:215-513-3052
Practice Address - Street 1:2700 SHELLY RD
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-1281
Practice Address - Country:US
Practice Address - Phone:215-513-3053
Practice Address - Fax:215-513-3052
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031185L183500000X
DEA10002778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018678030002Medicaid
PAPP481624OtherPA PERMIT
3986962OtherNCPDP
PA4415720002OtherNSC
1558469486OtherNPI
PA4415720002OtherMEDICARE NSC
PA4415720002OtherMEDICARE NSC
BL9983087OtherDEA