Provider Demographics
NPI:1811017817
Name:BARE, GWENDOLYN ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:ANN
Last Name:BARE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9707 GOODWARD CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3523
Mailing Address - Country:US
Mailing Address - Phone:804-272-8110
Mailing Address - Fax:804-714-0689
Practice Address - Street 1:5201 CHIPPENHAM CROSSING CTR
Practice Address - Street 2:UKROPS PHARMACY #485
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23234-6901
Practice Address - Country:US
Practice Address - Phone:804-714-0689
Practice Address - Fax:804-714-0712
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist