Provider Demographics
NPI:1477996098
Name:GARDNER, CATHERINE S (PHARM D)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:S
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 E 12TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-3528
Mailing Address - Country:US
Mailing Address - Phone:435-851-4597
Mailing Address - Fax:
Practice Address - Street 1:1320 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-3326
Practice Address - Country:US
Practice Address - Phone:970-625-9420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0019778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist