Provider Demographics
NPI:1053318436
Name:BERNARD, JEFFREY ALAN (RPH)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:BERNARD
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 1:1518 HACKNEY DR
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5001
Mailing Address - Country:US
Mailing Address - Phone:307-766-3090
Mailing Address - Fax:307-766-2953
Practice Address - Street 1:1000 E UNIVERSITY AVE
Practice Address - Street 2:DEPT. 3375
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82071-2000
Practice Address - Country:US
Practice Address - Phone:307-766-3090
Practice Address - Fax:307-766-2953
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist