Provider Demographics
NPI:1457641185
Name:BERNHARDT, GORDON LEE (RPH)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:LEE
Last Name:BERNHARDT
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 1:3112 E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5614
Mailing Address - Country:US
Mailing Address - Phone:303-399-7595
Mailing Address - Fax:303-311-5466
Practice Address - Street 1:3112 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5614
Practice Address - Country:US
Practice Address - Phone:303-399-7595
Practice Address - Fax:303-311-5466
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12293183500000X
CA40824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist