Healthcare Provider Details

I. General information

NPI: 1699441287
Provider Name (Legal Business Name): PENCOL SPECIALTY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 S. COLORADO BLVD, STE B-024
DENVER CO
80222
US

IV. Provider business mailing address

1325 S. COLORADO BLVD, STE B-024
DENVER CO
80222
US

V. Phone/Fax

Practice location:
  • Phone: 303-388-3613
  • Fax: 303-388-6182
Mailing address:
  • Phone: 303-388-3613
  • Fax: 303-388-6182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHERREE DISMUKE
Title or Position: MANAGER/OWNER
Credential:
Phone: 303-388-3613