Provider Demographics
NPI:1083482301
Name:GOVERNSKI, ROBERT (PHARMB)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:GOVERNSKI
Suffix:
Gender:M
Credentials:PHARMB
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:GOVERNSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMB
Mailing Address - Street 1:3883 BUFFALO RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:CO
Mailing Address - Zip Code:80456
Mailing Address - Country:US
Mailing Address - Phone:970-531-2193
Mailing Address - Fax:303-431-8320
Practice Address - Street 1:6650 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4906
Practice Address - Country:US
Practice Address - Phone:303-421-6111
Practice Address - Fax:303-431-8320
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO142251835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty