Provider Demographics
NPI:1588255178
Name:GERAK, JEFFREY (RPH)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:GERAK
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 1:1694 POPPLETON DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-4002
Mailing Address - Country:US
Mailing Address - Phone:313-802-4949
Mailing Address - Fax:
Practice Address - Street 1:1694 POPPLETON DR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-4002
Practice Address - Country:US
Practice Address - Phone:313-802-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist