Provider Demographics
NPI:1619278165
Name:GERGELY, ZACHARY
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:GERGELY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 ARAPAHOE AVE
Mailing Address - Street 2:SUITE E-4 #542
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-6720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 LEE HILL DR
Practice Address - Street 2:SUITE 200B
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-9471
Practice Address - Country:US
Practice Address - Phone:303-449-0089
Practice Address - Fax:303-443-0922
Is Sole Proprietor?:No
Enumeration Date:2010-11-14
Last Update Date:2010-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist