Provider Demographics
NPI:1962077966
Name:GIERWATOSKI, THOMAS PAUL (RPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:PAUL
Last Name:GIERWATOSKI
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 1:1610 PRAIRIE CENTER PKWY STE 2110
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-4001
Mailing Address - Country:US
Mailing Address - Phone:970-640-7698
Mailing Address - Fax:
Practice Address - Street 1:1610 PRAIRIE CENTER PKWY STE 2110
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4001
Practice Address - Country:US
Practice Address - Phone:970-640-7698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO36776858Medicaid