Individual provider Active NPI

Dean Matthew Gruber, RPH

  • Pharmacist
  • Milwaukee, WI
National Provider Identifier
1720079221
Registry record updated Oct 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
12973040 Issued in WI
Practice address
826 N Plankinton Ave Ste 100
Milwaukee, WI 53203-1832
Phone
(866) 746-3799
Fax
(414) 273-5986
NPI assigned
Nov 2, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 12973040 WI Primary

Addresses

Primary practice location

826 N Plankinton Ave Ste 100
Milwaukee, WI 53203-1832

Mailing address

4647 N Lake Dr
Whitefish Bay, WI 53211-1255
Phone (414) 276-4128

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
12973040WIMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350950400000",
    "number": "1720079221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4647 N LAKE DR",
            "city": "WHITEFISH BAY",
            "state": "WI",
            "postal_code": "532111255",
            "telephone_number": "414-276-4128",
            "fax_number": "414-273-5986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "826 N PLANKINTON AVE STE 100",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532031832",
            "telephone_number": "866-746-3799",
            "fax_number": "414-273-5986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUBER",
        "first_name": "DEAN",
        "middle_name": "MATTHEW",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2012-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "12973040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2012; 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.