Healthcare Provider Details

I. General information

NPI: 1023261906
Provider Name (Legal Business Name): ROGER ZUNDELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 TURNPIKE DR SUITE 209
WESTMINSTER CO
80031-7041
US

IV. Provider business mailing address

8501 TURNPIKE DR SUITE 209
WESTMINSTER CO
80031-7041
US

V. Phone/Fax

Practice location:
  • Phone: 303-430-6554
  • Fax: 303-430-6549
Mailing address:
  • Phone: 303-430-6554
  • Fax: 303-430-6549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number380101061165229
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: