Healthcare Provider Details

I. General information

NPI: 1366005464
Provider Name (Legal Business Name): AMBER PUTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 DENVER AVE
LOVELAND CO
80537-5120
US

IV. Provider business mailing address

1325 DENVER AVE
LOVELAND CO
80537-5120
US

V. Phone/Fax

Practice location:
  • Phone: 970-669-3891
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14916
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: