1336137017 NPI number — MR. DAVID RUSSELL GUTEKUNST RPH

Table of content: MR. DAVID RUSSELL GUTEKUNST RPH (NPI 1336137017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336137017 NPI number — MR. DAVID RUSSELL GUTEKUNST RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUTEKUNST
Provider First Name:
DAVID
Provider Middle Name:
RUSSELL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336137017
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 SHELLY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARLEYSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19438-1201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-513-3053
Provider Business Mailing Address Fax Number:
215-513-3052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 SHELLY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLEYSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19438-1281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-513-3053
Provider Business Practice Location Address Fax Number:
215-513-3052
Provider Enumeration Date:
10/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RP031185L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: A10002778 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0018678030002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: PP481624 . This is a "PA PERMIT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3986962 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4415720002 . This is a "NSC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1558469486 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4415720002 . This is a "MEDICARE NSC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com