Healthcare Provider Details

I. General information

NPI: 1740903640
Provider Name (Legal Business Name): NICOLE KOVAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1173 BERGEN PKWY
EVERGREEN CO
80439-9522
US

IV. Provider business mailing address

2100 N URSULA ST UNIT 319
AURORA CO
80045-7410
US

V. Phone/Fax

Practice location:
  • Phone: 303-674-8246
  • Fax: 303-670-6840
Mailing address:
  • Phone: 720-626-2658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA.0024177
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPHA.0024177
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: