MEDICARE: 2ND HOME PHARMACY - EVANS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	207VG0400X	Gynecology Physician
3	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1740157866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	2ND HOME PHARMACY - EVANS LLC

Provider Business Mailing Address
First Line	:	3131 S VAUGHN WAY STE 600
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80014-3508
Country	:	US
Telephone Number	:	303-999-7763
Fax Number	:

Provider Business Practice Location Address
First Line	:	6880 E EVANS AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80224-2330
Country	:	US
Telephone Number	:	303-999-7763
Fax Number	:	303-999-7763

Authorized Official
Title or Position	:	CEO
Name	:	HANEEN M OMAR
Credential	:	MRS
Telephone Number	:	303-999-7763

Provider Enumeration Date	:	10/22/2025
Last Update Date	:	10/22/2025

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