Healthcare Provider Details

I. General information

NPI: 1750730883
Provider Name (Legal Business Name): IVAN MONTOYA PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 W WILDCAT RESERVE PKWY
HIGHLANDS RANCH CO
80129-5496
US

IV. Provider business mailing address

2205 W WILDCAT RESERVE PKWY
HIGHLANDS RANCH CO
80129-5496
US

V. Phone/Fax

Practice location:
  • Phone: 720-344-0334
  • Fax: 720-344-4348
Mailing address:
  • Phone: 720-344-0334
  • Fax: 720-344-4348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPHA.0024753
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008535
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: