Healthcare Provider Details

I. General information

NPI: 1598149023
Provider Name (Legal Business Name): KRAIG KOCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 S BROADWAY
DENVER CO
80209-1511
US

IV. Provider business mailing address

10414 W PEAKVIEW PL
LITTLETON CO
80127-5562
US

V. Phone/Fax

Practice location:
  • Phone: 303-744-8660
  • Fax:
Mailing address:
  • Phone: 303-905-6398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number15191
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: