Healthcare Provider Details

I. General information

NPI: 1477995595
Provider Name (Legal Business Name): JILLIAN MARIE MULLENDORE PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILLIAN MARIE KOCZELA PHARMD, RPH

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 HAHNS PEAK DR
LOVELAND CO
80538-8852
US

IV. Provider business mailing address

2001 S SHIELDS ST BLDG I
FORT COLLINS CO
80526-1827
US

V. Phone/Fax

Practice location:
  • Phone: 970-962-4900
  • Fax: 970-221-5206
Mailing address:
  • Phone: 970-221-5255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPHA.0019888
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPHA.0019888
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: