Healthcare Provider Details

I. General information

NPI: 1306249024
Provider Name (Legal Business Name): CENTURA HEALTH PHARMACY AT ST. ANTHONY NORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 ORCHARD PKWY OUTPATIENT PHARMACY
WESTMINSTER CO
80023-9206
US

IV. Provider business mailing address

14300 ORCHARD PKWY OUTPATIENT PHARMACY
WESTMINSTER CO
80023-9206
US

V. Phone/Fax

Practice location:
  • Phone: 720-627-0090
  • Fax:
Mailing address:
  • Phone: 720-627-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPDO.1680000062
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPDO.1680000062
License Number StateCO

VIII. Authorized Official

Name: DR. BRANDON WAYNE FERLAS
Title or Position: PHARMACY MANAGER
Credential: PHARMD, MS
Phone: 720-627-0090