Provider Demographics
NPI:1497023469
Name:BADER, CHERYL (DPH)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:BADER
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2690 WHITE ROCK LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-4602
Mailing Address - Country:US
Mailing Address - Phone:719-499-8847
Mailing Address - Fax:
Practice Address - Street 1:2690 WHITE ROCK LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-4602
Practice Address - Country:US
Practice Address - Phone:719-499-8847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6159183500000X
CO11884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist