Healthcare Provider Details

I. General information

NPI: 1598801615
Provider Name (Legal Business Name): FRONT RANGE FLU SHOTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7421 S CURTICE CT
LITTLETON CO
80120-3952
US

IV. Provider business mailing address

7421 S CURTICE CT
LITTLETON CO
80120-3952
US

V. Phone/Fax

Practice location:
  • Phone: 303-797-3396
  • Fax:
Mailing address:
  • Phone: 303-797-3396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MRS. EILEEN R. NICKEL
Title or Position: PRESIDENT
Credential: RN, BSN
Phone: 303-797-3396