Healthcare Provider Details

I. General information

NPI: 1235411323
Provider Name (Legal Business Name): JEANNIE U.C. WERTH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 ARAPAHOE AVE STE 120
BOULDER CO
80303-1082
US

IV. Provider business mailing address

4745 ARAPAHOE AVE STE 120
BOULDER CO
80303-1082
US

V. Phone/Fax

Practice location:
  • Phone: 720-214-0963
  • Fax: 720-214-0969
Mailing address:
  • Phone: 720-214-0963
  • Fax: 720-214-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16777
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: