Healthcare Provider Details

I. General information

NPI: 1487918561
Provider Name (Legal Business Name): HEARTLAND PHARMACY - DENVER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8599 PRAIRIE TRAIL DR STE A300
ENGLEWOOD CO
80112-7100
US

IV. Provider business mailing address

1790 SABIN DR SUITE C
AMMON ID
83406-6747
US

V. Phone/Fax

Practice location:
  • Phone: 208-552-7677
  • Fax: 208-552-2103
Mailing address:
  • Phone: 208-552-7677
  • Fax: 208-552-2103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANDREA FERGUSON
Title or Position: EXECITIVE ASSISTANT
Credential:
Phone: 208-497-3575