Healthcare Provider Details

I. General information

NPI: 1699052902
Provider Name (Legal Business Name): JEFFREY L SUGARMAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 CONSTITUTION AVE
COLORADO SPRINGS CO
80915-1220
US

IV. Provider business mailing address

2735 CHARLOTTESVILLE DR
COLORADO SPRINGS CO
80922-1147
US

V. Phone/Fax

Practice location:
  • Phone: 719-591-9929
  • Fax: 719-591-5829
Mailing address:
  • Phone: 719-573-1177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number14536
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: