Michael Gremban
Individual provider Active NPI Pharmacist · West Milwaukee, WI
NPI 1003414822 · NPPES record last updated Oct 14, 2020
Key facts
- NPI
- 1003414822
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 17947-40 (WI)
- Practice address
- 4140 W Greenfield Ave
West Milwaukee, WI 53215-1334 - Phone
- (414) 978-2007
- Fax
- (414) 978-2008
- NPI assigned
- Oct 14, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17947-40 | WI | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 17947-40 | WI | Yes |
Addresses
Primary practice location
4140 W Greenfield Ave
West Milwaukee, WI 53215-1334
Mailing address
106 Woodlark CT
Waukesha, WI 53186-1257
Phone (920) 265-4571
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- Sandra Graham
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- Trista M Grudzinski
- Audra L Hale
- Kourtney K Haller
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- Mia D Hardison
All providers in West Milwaukee, WI · Pharmacist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.