Healthcare Provider Details

I. General information

NPI: 1659713964
Provider Name (Legal Business Name): KEDAR GURJAR PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2013
Last Update Date: 07/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 HIGHWAY 133
CARBONDALE CO
81623-1874
US

IV. Provider business mailing address

2118 BLAKE AVE
GLENWOOD SPRINGS CO
81601-4231
US

V. Phone/Fax

Practice location:
  • Phone: 970-963-5727
  • Fax:
Mailing address:
  • Phone: 301-910-8390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0019815
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: