Provider Demographics
NPI:1881638534
Name:GARDNER, GEORGE KEVIN (RPH)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:KEVIN
Last Name:GARDNER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 SHERRYE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-4425
Mailing Address - Country:US
Mailing Address - Phone:214-502-8958
Mailing Address - Fax:
Practice Address - Street 1:1748 N GREENVILLE AVE
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-1808
Practice Address - Country:US
Practice Address - Phone:214-502-8958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28050183500000X
MI5302033222183500000X
ARPD09056183500000X
NE12224183500000X
LA17564183500000X
KY013146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist