Healthcare Provider Details

I. General information

NPI: 1013845080
Provider Name (Legal Business Name): NATHAN HANTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 ARAPAHOE AVE
BOULDER CO
80303-1131
US

IV. Provider business mailing address

745 E SOUTH BOULDER RD APT E138
LOUISVILLE CO
80027-2540
US

V. Phone/Fax

Practice location:
  • Phone: 303-415-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA.0022175
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: