Provider Demographics
NPI:1407951445
Name:BISHARD, MARK RICHARD (PHARM-D)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:RICHARD
Last Name:BISHARD
Suffix:
Gender:M
Credentials:PHARM-D
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:RICHARD
Other - Last Name:BISHARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM-D RPH
Mailing Address - Street 1:8300 W 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6005
Mailing Address - Country:US
Mailing Address - Phone:303-403-3548
Mailing Address - Fax:303-467-8961
Practice Address - Street 1:8300 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6005
Practice Address - Country:US
Practice Address - Phone:303-403-3548
Practice Address - Fax:303-467-8961
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO136261835X0200X
CO132621835G0303X, 1835P1300X, 1835N1003X, 183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835X0200XPharmacy Service ProvidersPharmacistOncology
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No183500000XPharmacy Service ProvidersPharmacist