Provider Demographics
NPI:1720079221
Name:GRUBER, DEAN MATTHEW (RPH)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:MATTHEW
Last Name:GRUBER
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 1:4647 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1255
Mailing Address - Country:US
Mailing Address - Phone:414-276-4128
Mailing Address - Fax:414-273-5986
Practice Address - Street 1:826 N PLANKINTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-1832
Practice Address - Country:US
Practice Address - Phone:866-746-3799
Practice Address - Fax:414-273-5986
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12973040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist