Provider Demographics
NPI:1427786839
Name:GERHARDT, KENNETH JACOB JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:JACOB
Last Name:GERHARDT
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N7573 1090TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-4914
Mailing Address - Country:US
Mailing Address - Phone:651-472-1330
Mailing Address - Fax:
Practice Address - Street 1:1915 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-2605
Practice Address - Country:US
Practice Address - Phone:262-377-0352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3619240253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21327-40OtherPHARMACY LICENSE
WI1481650OtherNATIONAL ASSOCIATION OF BOARD OF PHARMACIS