Healthcare Provider Details

I. General information

NPI: 1043817414
Provider Name (Legal Business Name): JANE ELIZABETH OBRADOVICH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 KEN PRATT BLVD
LONGMONT CO
80501-6362
US

IV. Provider business mailing address

1050 KEN PRATT BLVD
LONGMONT CO
80501-6362
US

V. Phone/Fax

Practice location:
  • Phone: 303-682-0598
  • Fax:
Mailing address:
  • Phone: 303-682-0598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.303694
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20544-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: