Healthcare Provider Details

I. General information

NPI: 1508261637
Provider Name (Legal Business Name): PAMELA BLOOM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MARSHALL RD
SUPERIOR CO
80027-8623
US

IV. Provider business mailing address

400 MARSHALL RD
SUPERIOR CO
80027-8623
US

V. Phone/Fax

Practice location:
  • Phone: 303-209-0107
  • Fax:
Mailing address:
  • Phone: 303-209-0107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20301
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS48444
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: