Provider Demographics
NPI:1043421407
Name:BOKHART, GORDON HENRY (PHARM D)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:HENRY
Last Name:BOKHART
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 1:15901 BLUFFTON RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46819-9523
Mailing Address - Country:US
Mailing Address - Phone:260-622-4967
Mailing Address - Fax:260-435-6739
Practice Address - Street 1:7950 W JEFFERSON BLVD
Practice Address - Street 2:RESEARCH DEPARTMENT
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4140
Practice Address - Country:US
Practice Address - Phone:260-435-7718
Practice Address - Fax:260-435-6739
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013510A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist