Gary Dean
Individual provider Active NPI Pharmacist · Delavan, WI
NPI 1407286271 · NPPES record last updated Nov 15, 2013
Key facts
- NPI
- 1407286271
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 8544 (WI)
- Practice address
- 1450 E. Geneva St.
Delavan, WI 53115-4201 - Phone
- (262) 728-0062
- Fax
- (262) 728-0055
- NPI assigned
- Nov 15, 2013
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 8544 | WI | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 8544 | WI | Yes |
Addresses
Primary practice location
1450 E. Geneva St.
Delavan, WI 53115-4201
Mailing address
1450 E Geneva St
Delavan, WI 53115-2025
Phone (262) 728-0062
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8544 | Other | WI | PHARMACY LICENSE NUMBER |
Other providers in Delavan, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2013. 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.