1861405482 NPI number — DR. REBEKAH ELIZABETH GEBHARDS PHARM.D

Table of content: (NPI 1225253958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861405482 NPI number — DR. REBEKAH ELIZABETH GEBHARDS PHARM.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEBHARDS
Provider First Name:
REBEKAH
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861405482
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20075 STATE HIGHWAY Y
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCK PORT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64482-7121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-744-2161
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TARKIO
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64491-1544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-736-5512
Provider Business Practice Location Address Fax Number:
660-736-4361
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  12030 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 2004033682 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 12030 . This is a "PHARMACIST LISCENSE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 2004033682 . This is a "PHARMACIST LISCENSE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 20138 . This is a "PHARMACY BOARD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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