Provider Demographics
NPI:1659713964
Name:GURJAR, KEDAR (PHARMD)
Entity Type:Individual
Prefix:
First Name:KEDAR
Middle Name:
Last Name:GURJAR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 BLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4231
Mailing Address - Country:US
Mailing Address - Phone:301-910-8390
Mailing Address - Fax:
Practice Address - Street 1:1051 HIGHWAY 133
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-1874
Practice Address - Country:US
Practice Address - Phone:970-963-5727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-28
Last Update Date:2013-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0019815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist