Healthcare Provider Details

I. General information

NPI: 1134632706
Provider Name (Legal Business Name): GARY VICTOR FRIEDMAN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 SPICEWOOD SPRINGS ROAD #1111
AUSTIN TN
78759
US

IV. Provider business mailing address

4411 SPICEWOOD SPRINGS RD APT 1111
AUSTIN TX
78759-8573
US

V. Phone/Fax

Practice location:
  • Phone: 303-882-8257
  • Fax:
Mailing address:
  • Phone: 303-882-8257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number14496
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: