Individual
DR. KENNETH JACOB GERHARDT JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1915 WISCONSIN AVE, GRAFTON, WI 53024-2605
(262) 377-0352
Mailing address
N7573 1090TH ST, RIVER FALLS, WI 54022-4914
(651) 472-1330
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
361924025
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1481650
NATIONAL ASSOCIATION OF BOARD OF PHARMACIS
WI
01
—
21327-40
PHARMACY LICENSE
WI
Enumeration date
08/12/2022
Last updated
08/12/2022
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