Provider Demographics
NPI:1386961290
Name:RESCHKE, GERALD SCOTT (BS PHARMACY)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:SCOTT
Last Name:RESCHKE
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 E APPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3762
Mailing Address - Country:US
Mailing Address - Phone:231-773-9188
Mailing Address - Fax:231-773-1451
Practice Address - Street 1:1501 E APPLE AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3762
Practice Address - Country:US
Practice Address - Phone:231-773-9188
Practice Address - Fax:231-773-1451
Is Sole Proprietor?:No
Enumeration Date:2010-05-02
Last Update Date:2010-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027649183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist