Provider Demographics
NPI:1861850380
Name:GARDNER, JOHN (PHARMD PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:GARDNER
Suffix:
Gender:M
Credentials:PHARMD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2260
Mailing Address - Country:US
Mailing Address - Phone:540-819-0417
Mailing Address - Fax:
Practice Address - Street 1:3735 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-2260
Practice Address - Country:US
Practice Address - Phone:540-819-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA5 0 164 2 41835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy