Healthcare Provider Details

I. General information

NPI: 1982964862
Provider Name (Legal Business Name): JEREMY GRADISAR PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7190 E HAMPDEN AVE
DENVER CO
80224-3014
US

IV. Provider business mailing address

7190 E HAMPDEN AVE
DENVER CO
80224-3014
US

V. Phone/Fax

Practice location:
  • Phone: 303-773-6154
  • Fax:
Mailing address:
  • Phone: 303-773-6154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19365
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: