MEDICARE: MR. SCOTT R BORDON RPH

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	11509	CO

General Provider Information

NPI Number	:	1538144134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT R BORDON RPH

Provider Business Mailing Address
First Line	:	633 SILVER OAK DR
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1068
Country	:	US
Telephone Number	:	970-257-0718
Fax Number	:

Provider Business Practice Location Address
First Line	:	633 SILVER OAK DR
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1068
Country	:	US
Telephone Number	:	970-257-0718
Fax Number	:

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

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	11/08/2010

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