Provider Demographics
NPI:1346540390
Name:VAN LOAN, PAULA GENTRY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:GENTRY
Last Name:VAN LOAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 W 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-1305
Mailing Address - Country:US
Mailing Address - Phone:303-477-1470
Mailing Address - Fax:
Practice Address - Street 1:3800 W 44TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-1305
Practice Address - Country:US
Practice Address - Phone:303-477-1470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist