Healthcare Provider Details

I. General information

NPI: 1235054073
Provider Name (Legal Business Name): KATHRYN DIANE BEAVERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

977 FILLMORE ST
DENVER CO
80206-3851
US

IV. Provider business mailing address

977 FILLMORE ST
DENVER CO
80206-3851
US

V. Phone/Fax

Practice location:
  • Phone: 706-537-0987
  • Fax:
Mailing address:
  • Phone: 706-537-0987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18045
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: