Healthcare Provider Details

I. General information

NPI: 1174600209
Provider Name (Legal Business Name): HALDUN INC A COLORADO CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 W 38TH AVE
WHEAT RIDGE CO
80033-4906
US

IV. Provider business mailing address

6650 W 38TH AVE
WHEAT RIDGE CO
80033-4906
US

V. Phone/Fax

Practice location:
  • Phone: 303-421-6111
  • Fax: 303-431-8320
Mailing address:
  • Phone: 303-421-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1280000012
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JIM MASSENGILL
Title or Position: PRESIDENT
Credential:
Phone: 303-421-6111