Provider Demographics
NPI:1023261906
Name:ZUNDELL, ROGER
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:ZUNDELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 TURNPIKE DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-7041
Mailing Address - Country:US
Mailing Address - Phone:303-430-6554
Mailing Address - Fax:303-430-6549
Practice Address - Street 1:8501 TURNPIKE DR
Practice Address - Street 2:SUITE 209
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-7041
Practice Address - Country:US
Practice Address - Phone:303-430-6554
Practice Address - Fax:303-430-6549
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO380101061165229183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician