MEDICARE: DR. JOHN GARDNER PHARMD PHD

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	1835P1200X	Pharmacotherapy Pharmacist	5 0 164 2 4	VA

General Provider Information

NPI Number	:	1861850380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN GARDNER PHARMD PHD

Provider Business Mailing Address
First Line	:	3735 FRANKLIN RD SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24014-2260
Country	:	US
Telephone Number	:	540-819-0417
Fax Number	:

Provider Business Practice Location Address
First Line	:	3735 FRANKLIN RD SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24014-2260
Country	:	US
Telephone Number	:	540-819-0417
Fax Number	:

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

Provider Enumeration Date	:	01/29/2016
Last Update Date	:	01/29/2016

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