Provider Demographics
NPI:1700918232
Name:GINGREAU, JAROD PAUL (RPH)
Entity Type:Individual
Prefix:
First Name:JAROD
Middle Name:PAUL
Last Name:GINGREAU
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 1:3781 S BRUST AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-4061
Mailing Address - Country:US
Mailing Address - Phone:414-294-0975
Mailing Address - Fax:
Practice Address - Street 1:3781 S BRUST AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-4061
Practice Address - Country:US
Practice Address - Phone:414-294-0975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist