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General NPI Number Information
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NPI Number | 1306249024
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Entity Type | Organization
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Legal Business Name | CENTURA HEALTH PHARMACY AT ST. ANTHONY NORTH
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Dates
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Enumeration Date | 10/08/2014
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Last Update Date | 03/24/2016
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Provider Practice Location Address
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Address Line | 14300 ORCHARD PKWY OUTPATIENT PHARMACY
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City | WESTMINSTER
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State | CO
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Zip | 80023-9206
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Country | US
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Telephone | 720-627-0090
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Fax |
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Provider Business Mailing Address
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Address Line | 14300 ORCHARD PKWY OUTPATIENT PHARMACY
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City | WESTMINSTER
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State | CO
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Zip | 80023-9206
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Country | US
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Telephone | 720-627-0090
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | DR. BRANDON WAYNE FERLAS
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Credential | PHARMD, MS
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Telephone | 720-627-0090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | PDO.1680000062
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PDO.1680000062
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License Number State | CO
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