Healthcare Provider Details

I. General information

NPI: 1851955439
Provider Name (Legal Business Name): STEPHANIE WIENKERS CLINICAL PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 04/30/2024
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 S FEDERAL BLVD
DENVER CO
80219-4235
US

IV. Provider business mailing address

1339 S FEDERAL BLVD
DENVER CO
80219-4235
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-0083
  • Fax:
Mailing address:
  • Phone: 303-602-0083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPHA.0023159
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA.0023159
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: