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General NPI Number Information
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NPI Number | 1669118808
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Entity Type | Individual
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Provider Name | JEREMIAH MICHAEL STELLISH RPH
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Gender | Male
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Dates
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Enumeration Date | 05/10/2022
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 3600 TABLE MESA DR
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City | BOULDER
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State | CO
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Zip | 80305-5895
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Country | US
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Telephone | 303-499-4244
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Fax | 303-497-2204
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Provider Business Mailing Address
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Address Line | 19566 W 56TH DR
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City | GOLDEN
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State | CO
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Zip | 80403-2167
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Country | US
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Telephone | 303-905-7143
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 14838
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License Number State | CO
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