Individual provider Active NPI

Eric Robert Gresens, RPH

  • Pharmacist
  • Edgerton, WI
National Provider Identifier
1083733448
Registry record updated Sep 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
12874 Issued in WI
Practice address
711 N Main St
Edgerton, WI 53534-1530
Phone
(608) 884-3308
Fax
(608) 884-7725
NPI assigned
Mar 28, 2007
Last updated
Sep 12, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 12874 WI Primary

Addresses

Primary practice location

711 N Main St
Edgerton, WI 53534-1530

Mailing address

379 E Samuelsen Dr
Edgerton, WI 53534-8412
Phone (608) 449-0095

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
12874WIMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Rockmed LLC CurrentSince Sep 15, 2019 Accepting new patients

Locations

711 N Main St
Edgerton, WI 53534
Phone (608) 884-3308

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568246400000",
    "number": "1083733448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "379 E SAMUELSEN DR",
            "city": "EDGERTON",
            "state": "WI",
            "postal_code": "535348412",
            "telephone_number": "608-449-0095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 N MAIN ST",
            "city": "EDGERTON",
            "state": "WI",
            "postal_code": "535341530",
            "telephone_number": "608-884-3308",
            "fax_number": "608-884-7725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRESENS",
        "first_name": "ERIC",
        "middle_name": "ROBERT",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-28",
        "last_updated": "2019-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "12874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgerton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.