=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164723698
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH ANN NINE PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2010
-----------------------------------------------------
Last Update Date | 11/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 620 W PLATTE AVE
-----------------------------------------------------
City | FORT MORGAN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80701-2652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-867-3027
-----------------------------------------------------
Fax | 970-867-6580
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7476 E ARKANSAS AVE APT 3608
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80231-2548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-669-6047
-----------------------------------------------------
Fax | 970-867-6580
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 18843
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------