Healthcare Provider Details

I. General information

NPI: 1275976516
Provider Name (Legal Business Name): DR. KASSANDRA RUMBAUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 NORTH SPEER BLVD
DENVER CO
80204
US

IV. Provider business mailing address

1331 NORTH SPEER BLVD
DENVER CO
80204
US

V. Phone/Fax

Practice location:
  • Phone: 303-571-1943
  • Fax: 303-899-5888
Mailing address:
  • Phone: 303-571-1943
  • Fax: 303-899-5888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18400
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: