Healthcare Provider Details

I. General information

NPI: 1710384961
Provider Name (Legal Business Name): JONATHAN MATTHEW LUPPENS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

1926 PINE GROVE AVE
COLORADO SPRINGS CO
80906-2932
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-2525
  • Fax:
Mailing address:
  • Phone: 719-629-6652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA.0019571
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: