Healthcare Provider Details

I. General information

NPI: 1912909987
Provider Name (Legal Business Name): POUDRE INFUSION THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 CENTRE AVE SUITE 3
FORT COLLINS CO
80526-6045
US

IV. Provider business mailing address

915 CENTRE AVE
FORT COLLINS CO
80526-6045
US

V. Phone/Fax

Practice location:
  • Phone: 970-494-2130
  • Fax: 970-494-2131
Mailing address:
  • Phone: 970-494-2130
  • Fax: 970-494-9815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number440000021
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number440000021
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number440000021
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number440000021
License Number StateCO

VIII. Authorized Official

Name: LAUREN N STACKHOUSE
Title or Position: PIC
Credential:
Phone: 970-494-2130