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General NPI Number Information
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NPI Number | 1457641185
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Entity Type | Individual
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Provider Name | GORDON LEE BERNHARDT RPH
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Gender | Male
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Dates
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Enumeration Date | 04/14/2011
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Last Update Date | 04/14/2011
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Provider Practice Location Address
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Address Line | 3112 E 1ST AVE
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City | DENVER
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State | CO
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Zip | 80206-5614
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Country | US
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Telephone | 303-399-7595
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Fax | 303-311-5466
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Provider Business Mailing Address
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Address Line | 3112 E 1ST AVE
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City | DENVER
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State | CO
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Zip | 80206-5614
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Country | US
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Telephone | 303-399-7595
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Fax | 303-311-5466
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 12293
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 40824
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License Number State | CA
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