MEDICARE: GARY LAVERNE PULVERMACHER 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	14889	CO

General Provider Information

NPI Number	:	1760488928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY LAVERNE PULVERMACHER RPH

Provider Business Mailing Address
First Line	:	3640 NEEDLES DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-1351
Country	:	US
Telephone Number	:	719-481-4936
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 BROADWAY
Second Line	:	STE 700
City	:	DENVER
State	:	CO
Zip	:	80202-4967
Country	:	US
Telephone Number	:	303-844-2760
Fax Number	:

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/08/2007

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