Individual
JERRY VANDIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
508 E MAIN ST, CORTEZ, CO 81321-3307
(970) 565-6466
(970) 565-2152
Mailing address
508 E MAIN ST, CORTEZ, CO 81321-3307
(970) 565-6466
(970) 565-2152
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11974
CO
Other
Enumeration date
04/06/2013
Last updated
04/06/2013
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