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NPI Code Detail

MEDICARE: KELLY RAE ENSMINGER RPH

MEDICARE: KELLY RAE ENSMINGER RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist13309CO

General Provider Information

NPI Number : 1538271168
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY RAE ENSMINGER RPH
Provider Business Mailing Address
First Line : 1367 S HUMBOLDT ST
Second Line :
City : DENVER
State : CO
Zip : 80210-2316
Country : US
Telephone Number : 303-885-3019
Fax Number :
Provider Business Practice Location Address
First Line : 4353 E COLFAX AVE
Second Line :
City : DENVER
State : CO
Zip : 80220-1115
Country : US
Telephone Number : 303-504-1299
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/08/2007

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