Provider Demographics
NPI:1043762784
Name:GERHARDSON, JEFF THOMAS (PHARM-D)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:THOMAS
Last Name:GERHARDSON
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 1:4531 SHANNON PL
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-6010
Mailing Address - Country:US
Mailing Address - Phone:530-244-8600
Mailing Address - Fax:530-244-8605
Practice Address - Street 1:4531 SHANNON PL
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-6010
Practice Address - Country:US
Practice Address - Phone:530-244-8600
Practice Address - Fax:530-244-8605
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist