Healthcare Provider Details

I. General information

NPI: 1740157866
Provider Name (Legal Business Name): 2ND HOME PHARMACY - EVANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6880 E EVANS AVE
DENVER CO
80224-2330
US

IV. Provider business mailing address

3131 S VAUGHN WAY STE 600
DENVER CO
80014-3508
US

V. Phone/Fax

Practice location:
  • Phone: 303-999-7763
  • Fax: 303-999-7763
Mailing address:
  • Phone: 303-999-7763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: HANEEN M OMAR
Title or Position: CEO
Credential: MRS
Phone: 303-999-7763