Healthcare Provider Details

I. General information

NPI: 1831917202
Provider Name (Legal Business Name): AUSTIN SADERUP PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

985 ALBION ST APT 343
DENVER CO
80220-4979
US

IV. Provider business mailing address

985 ALBION ST APT 343
DENVER CO
80220-4979
US

V. Phone/Fax

Practice location:
  • Phone: 909-838-0256
  • Fax:
Mailing address:
  • Phone: 909-838-0256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number0024793
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: