Provider Demographics
NPI:1437492600
Name:GOLD, ALFRED WAYNE (RPH)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:WAYNE
Last Name:GOLD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 HARTSEL DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4165
Mailing Address - Country:US
Mailing Address - Phone:719-590-7515
Mailing Address - Fax:719-590-7082
Practice Address - Street 1:3570 HARTSEL DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4165
Practice Address - Country:US
Practice Address - Phone:719-590-7515
Practice Address - Fax:719-590-7082
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist