Provider Demographics
NPI:1104869296
Name:GERDES, MICHAEL C (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:C
Last Name:GERDES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 JARED LN
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3664
Mailing Address - Country:US
Mailing Address - Phone:732-792-3926
Mailing Address - Fax:
Practice Address - Street 1:81 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-5279
Practice Address - Country:US
Practice Address - Phone:888-319-1818
Practice Address - Fax:877-290-1812
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02739500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist