Healthcare Provider Details

I. General information

NPI: 1881442838
Provider Name (Legal Business Name): JESSICA VAN LAREN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16601 E CENTRETECH PKWY
AURORA CO
80011-9045
US

IV. Provider business mailing address

6391 W 60TH AVE APT 102
ARVADA CO
80003-5623
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-3800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17941
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: