MEDICARE: CHERYL BADER D.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	6159	TN
2	183500000X	Pharmacist	11884	CO

General Provider Information

NPI Number	:	1497023469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL BADER D.PH.

Provider Business Mailing Address
First Line	:	2690 WHITE ROCK LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-4602
Country	:	US
Telephone Number	:	719-499-8847
Fax Number	:

Provider Business Practice Location Address
First Line	:	2690 WHITE ROCK LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-4602
Country	:	US
Telephone Number	:	719-499-8847
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2011
Last Update Date	:	12/06/2011

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