Provider Demographics
NPI:1831424647
Name:GJERDRUM, ERIC EIVIND (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:EIVIND
Last Name:GJERDRUM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2180 IDYLLWILD PL
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-9632
Mailing Address - Country:US
Mailing Address - Phone:805-343-5703
Mailing Address - Fax:
Practice Address - Street 1:1540 FROOM RANCH WAY
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-7211
Practice Address - Country:US
Practice Address - Phone:805-541-7028
Practice Address - Fax:805-541-7025
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00510701835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy