Provider Demographics
NPI:1033758511
Name:HERTFELDER, GUY C (PHARM D)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:C
Last Name:HERTFELDER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2334 PROVENANCE ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-3706
Mailing Address - Country:US
Mailing Address - Phone:303-913-6243
Mailing Address - Fax:
Practice Address - Street 1:835 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-3004
Practice Address - Country:US
Practice Address - Phone:303-651-7468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0016782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty