Provider Demographics
NPI:1932845963
Name:GARDNER, GREGORY (PHARMD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:GARDNER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12477 S RAMPART WAY
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-7766
Mailing Address - Country:US
Mailing Address - Phone:801-836-8438
Mailing Address - Fax:
Practice Address - Street 1:1557 E EAGLE MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005
Practice Address - Country:US
Practice Address - Phone:801-836-8438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7408839-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist