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General NPI Number Information
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NPI Number | 1346795903
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Entity Type | Organization
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Legal Business Name | KING SOOPERS
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Dates
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Enumeration Date | 08/23/2016
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Last Update Date | 08/23/2016
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Provider Practice Location Address
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Address Line | 65 TEJON ST
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City | DENVER
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State | CO
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Zip | 80223-1221
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Country | US
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Telephone | 314-757-4031
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Fax |
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Provider Business Mailing Address
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Address Line | 65 TEJON ST
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City | DENVER
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State | CO
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Zip | 80223-1221
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Country | US
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Telephone | 314-757-4031
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | IYOBOSA SANDRA OSA-EDOH
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Credential | PHARM.D
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Telephone | 314-757-4031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0021435
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License Number State | CO
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