Individual
GARY DEAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1450 E. GENEVA ST., DELAVAN, WI 53115-4201
(262) 728-0062
(262) 728-0055
Mailing address
1450 E GENEVA ST, DELAVAN, WI 53115-2025
(262) 728-0062
(262) 728-0055
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
8544
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8544
PHARMACY LICENSE NUMBER
WI
Enumeration date
11/15/2013
Last updated
11/15/2013
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