Healthcare Provider Details

I. General information

NPI: 1295648251
Provider Name (Legal Business Name): JEREMIAH CLEVELAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16375 WASHINGTON ST
THORNTON CO
80023-8907
US

IV. Provider business mailing address

3590 E 102ND AVE
THORNTON CO
80229-2897
US

V. Phone/Fax

Practice location:
  • Phone: 303-474-3254
  • Fax: 303-474-3251
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25657
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: