Provider Demographics
NPI:1871621425
Name:GRAMLING, CHARLES MICHAEL (R PH)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:MICHAEL
Last Name:GRAMLING
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28854 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LINDSTROM
Mailing Address - State:MN
Mailing Address - Zip Code:55045-9619
Mailing Address - Country:US
Mailing Address - Phone:651-257-3138
Mailing Address - Fax:
Practice Address - Street 1:10655 RAILROAD AVE
Practice Address - Street 2:PO BOX D
Practice Address - City:CHISAGO CITY
Practice Address - State:MN
Practice Address - Zip Code:55013-9442
Practice Address - Country:US
Practice Address - Phone:651-257-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist