Healthcare Provider Details

I. General information

NPI: 1205403649
Provider Name (Legal Business Name): ANNETTE BLUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 ARAPAHOE AVE STE 120
BOULDER CO
80303-1082
US

IV. Provider business mailing address

8000 UPTOWN AVE APT J2089
BROOMFIELD CO
80021-4795
US

V. Phone/Fax

Practice location:
  • Phone: 720-214-0963
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0023537
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: