Provider Demographics
NPI:1902029820
Name:HAM, ALAN ROBERT (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:ROBERT
Last Name:HAM
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 CAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-1868
Mailing Address - Country:US
Mailing Address - Phone:970-314-2235
Mailing Address - Fax:970-245-3978
Practice Address - Street 1:1834 N 12TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-7612
Practice Address - Country:US
Practice Address - Phone:970-243-3125
Practice Address - Fax:970-245-3978
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist