=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215604053
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMELA URBAN PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2021
-----------------------------------------------------
Last Update Date | 08/29/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1700 BASSETT ST UNIT 2122
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80202-1946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-231-2125
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1700 BASSETT ST UNIT 2122
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80202-1946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-231-2125
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | 18723
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------