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General NPI Number Information
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NPI Number | 1699441287
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Entity Type | Organization
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Legal Business Name | PENCOL SPECIALTY PHARMACY LLC
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Dates
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Enumeration Date | 08/23/2021
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Last Update Date | 08/23/2021
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Provider Practice Location Address
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Address Line | 1325 S. COLORADO BLVD, STE B-024
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City | DENVER
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State | CO
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Zip | 80222
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Country | US
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Telephone | 303-388-3613
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Fax | 303-388-6182
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Provider Business Mailing Address
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Address Line | 1325 S. COLORADO BLVD, STE B-024
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City | DENVER
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State | CO
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Zip | 80222
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Country | US
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Telephone | 303-388-3613
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Fax | 303-388-6182
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | SHERREE DISMUKE
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Credential |
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Telephone | 303-388-3613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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