Healthcare Provider Details

I. General information

NPI: 1417739129
Provider Name (Legal Business Name): LAUREN ALEXIS QUINTANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 28TH ST
BOULDER CO
80301-1440
US

IV. Provider business mailing address

6900 S YOSEMITE ST
CENTENNIAL CO
80112-1412
US

V. Phone/Fax

Practice location:
  • Phone: 303-938-9284
  • Fax:
Mailing address:
  • Phone: 303-843-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24629
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: