Basic Information
| Provider Information | |||||||||
| NPI: | 1508878539 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GERLACH | ||||||||
| FirstName: | RICKI | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CPHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16426 MANCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | EASTPOINTE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480211128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5863067198 | ||||||||
| FaxNumber: | 3135761105 | ||||||||
| Practice Location | |||||||||
| Address1: | 4646 JOHN R ST | ||||||||
| Address2: | OUTPATIENT PHARMACY 118CP | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482011916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135764616 | ||||||||
| FaxNumber: | 3135761105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 07/13/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183700000X | 1401-0452-0763-960 | DC | Y | Pharmacy Service Providers | Pharmacy Technician | 136A00000X | N | Dietary & Nutritional Service Providers | Dietetic Technician, Registered |
No ID Information.