Provider Demographics
NPI:1780675728
Name:BARBER, GARY NELSON (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:NELSON
Last Name:BARBER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:GARY
Other - Middle Name:NELSON
Other - Last Name:BARBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:2583 WINONA DR
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:MI
Mailing Address - Zip Code:49266-5801
Mailing Address - Country:US
Mailing Address - Phone:517-437-1340
Mailing Address - Fax:
Practice Address - Street 1:30 N HOWELL ST
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1621
Practice Address - Country:US
Practice Address - Phone:517-437-4497
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302020344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist