Individual
MR. GERVASIS MANUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D
Contact information
Practice address
2845 W CLEVELAND RD, SOUTH BEND, IN 46628-6188
(574) 277-1538
Mailing address
1460 SIOUX TRL, NILES, MI 49120-3136
(269) 682-0404
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302035864
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051291744
LICENSE
IL
01
—
26022347A
LICENCE
IN
01
—
5302035864
LICENSE
MI
Enumeration date
03/14/2007
Last updated
01/26/2011
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