Healthcare Provider Details

I. General information

NPI: 1134722515
Provider Name (Legal Business Name): SUSAN HEGSTROM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E 120TH AVE
THORNTON CO
80233-5711
US

IV. Provider business mailing address

19522 E SUNSET CIR
CENTENNIAL CO
80015-2887
US

V. Phone/Fax

Practice location:
  • Phone: 303-280-6273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number124575
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA.0022900
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: