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General NPI Number Information
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NPI Number | 1528287273
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Entity Type | Individual
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Provider Name | GARY STEPHEN BODNAR RPH
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Gender | Male
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6225 ANNIE OAKLEY DR
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City | LAS VEGAS
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State | NV
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Zip | 89120-3914
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Country | US
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Telephone | 702-436-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 8310 CAMPANA DR
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City | LAS VEGAS
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State | NV
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Zip | 89147-5218
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Country | US
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Telephone | 702-873-6071
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Fax |
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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 | 13499
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License Number State | NV
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