Healthcare Provider Details

I. General information

NPI: 1508848938
Provider Name (Legal Business Name): JOHN W GEDDES RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

0210 CRESTWOOD DRIVE
GYPSUM CO
81637-1220
US

IV. Provider business mailing address

0042 NEWQUIST ST PO BOX 4403
EAGLE CO
81631-4403
US

V. Phone/Fax

Practice location:
  • Phone: 970-524-1125
  • Fax: 970-524-0478
Mailing address:
  • Phone: 970-328-1533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9993
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: