Healthcare Provider Details

I. General information

NPI: 1639623218
Provider Name (Legal Business Name): ASHLEY NICOLE POKALLUS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY NICOLE VIGIL

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 S LEMAY AVE STE 200
FORT COLLINS CO
80524-3959
US

IV. Provider business mailing address

2001 S SHIELDS ST BLDG I
FORT COLLINS CO
80526-1827
US

V. Phone/Fax

Practice location:
  • Phone: 970-484-1757
  • Fax: 970-484-9924
Mailing address:
  • Phone: 970-221-5255
  • Fax: 970-221-5206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA.0021877
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number25325
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPHA.0021877
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: