Provider Demographics
NPI:1760488928
Name:PULVERMACHER, GARY LAVERNE (RPH)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LAVERNE
Last Name:PULVERMACHER
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 1:3640 NEEDLES DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-1351
Mailing Address - Country:US
Mailing Address - Phone:719-481-4936
Mailing Address - Fax:
Practice Address - Street 1:1600 BROADWAY
Practice Address - Street 2:STE 700
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-4967
Practice Address - Country:US
Practice Address - Phone:303-844-2760
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist