MEDICARE: NATHAN RADER PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0021452	CO

General Provider Information

NPI Number	:	1528516978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN RADER PHARMD

Provider Business Mailing Address
First Line	:	4600 LEETSDALE DR
Second Line	:
City	:	GLENDALE
State	:	CO
Zip	:	80246-1311
Country	:	US
Telephone Number	:	303-320-3110
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 LEETSDALE DR
Second Line	:
City	:	GLENDALE
State	:	CO
Zip	:	80246-1311
Country	:	US
Telephone Number	:	303-320-3110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2016
Last Update Date	:	09/14/2016

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