Individual
DR. GAVIN RANDY KLOULUBAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
551 S HOVER ST, LONGMONT, CO 80501-7920
(720) 864-4394
Mailing address
16835 HURON ST APT 105, BROOMFIELD, CO 80023-8941
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
22422
CO
Other
Enumeration date
09/13/2019
Last updated
09/13/2019
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