Healthcare Provider Details

I. General information

NPI: 1376179432
Provider Name (Legal Business Name): ATHENA POWELL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 CHAMPA ST
DENVER CO
80205-2529
US

IV. Provider business mailing address

4455 E 12TH AVE
DENVER CO
80220-2415
US

V. Phone/Fax

Practice location:
  • Phone: 303-312-2217
  • Fax:
Mailing address:
  • Phone: 303-504-7670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16212
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0022936
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: