Provider Demographics
NPI:1053398644
Name:GUTGSELL, MAUREEN (RPH)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:GUTGSELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 MAUTE ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-1959
Mailing Address - Country:US
Mailing Address - Phone:812-482-2525
Mailing Address - Fax:812-482-9290
Practice Address - Street 1:US HWY 231 SOUTH
Practice Address - Street 2:
Practice Address - City:LOOGOOTEE
Practice Address - State:IN
Practice Address - Zip Code:47553
Practice Address - Country:US
Practice Address - Phone:812-295-2646
Practice Address - Fax:812-295-9495
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist