Healthcare Provider Details

I. General information

NPI: 1801466370
Provider Name (Legal Business Name): DENVER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3816 NC-16 BUSINESS
DENVER NC
28037
US

IV. Provider business mailing address

3816 NC-16 BUSINESS
DENVER NC
28037
US

V. Phone/Fax

Practice location:
  • Phone: 704-451-5051
  • Fax:
Mailing address:
  • Phone: 704-451-5051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JESIKA S PATEL
Title or Position: CO-CEO/ OWNER
Credential:
Phone: 704-451-3790