Healthcare Provider Details

I. General information

NPI: 1669118808
Provider Name (Legal Business Name): JEREMIAH MICHAEL STELLISH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 TABLE MESA DR
BOULDER CO
80305-5895
US

IV. Provider business mailing address

19566 W 56TH DR
GOLDEN CO
80403-2167
US

V. Phone/Fax

Practice location:
  • Phone: 303-499-4244
  • Fax: 303-497-2204
Mailing address:
  • Phone: 303-905-7143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number14838
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14838
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: