Provider Demographics
NPI:1508848938
Name:GEDDES, JOHN W (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:GEDDES
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 1:0042 NEWQUIST ST
Mailing Address - Street 2:PO BOX 4403
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-4403
Mailing Address - Country:US
Mailing Address - Phone:970-328-1533
Mailing Address - Fax:
Practice Address - Street 1:0210 CRESTWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:GYPSUM
Practice Address - State:CO
Practice Address - Zip Code:81637-1220
Practice Address - Country:US
Practice Address - Phone:970-524-1125
Practice Address - Fax:970-524-0478
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9993183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist