Provider Demographics
NPI:1427269968
Name:GUTSHALL, EDWIN L
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:L
Last Name:GUTSHALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 PELICAN REACH
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3708
Mailing Address - Country:US
Mailing Address - Phone:757-538-0615
Mailing Address - Fax:
Practice Address - Street 1:106 PELICAN REACH
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3708
Practice Address - Country:US
Practice Address - Phone:757-538-0615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02020049671835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy