Healthcare Provider Details

I. General information

NPI: 1558827675
Provider Name (Legal Business Name): ALEX ELIZABETH FREDERICK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEX ELIZABETH CRITZ-CULP PHARMD

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BLAKE AVE
GLENWOOD SPRINGS CO
81601-4259
US

IV. Provider business mailing address

PO BOX 5395
EAGLE CO
81631-5395
US

V. Phone/Fax

Practice location:
  • Phone: 970-384-7585
  • Fax: 970-384-6696
Mailing address:
  • Phone: 970-409-9407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number20487
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20487
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: