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General NPI Number Information
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NPI Number | 1811389174
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Entity Type | Organization
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Legal Business Name | WHEATRIDGE DRUG STORE LLC
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Dates
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Enumeration Date | 02/24/2015
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Last Update Date | 10/28/2021
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Provider Practice Location Address
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Address Line | 6650 W 38TH AVE
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City | WHEAT RIDGE
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State | CO
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Zip | 80033-4906
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Country | US
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Telephone | 303-421-6111
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Fax | 303-431-8320
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Provider Business Mailing Address
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Address Line | 6650 W 38TH AVE
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City | WHEAT RIDGE
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State | CO
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Zip | 80033-4906
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Country | US
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Telephone | 303-421-6111
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Fax | 303-431-8320
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | WENDY DILORENZO
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Credential |
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Telephone | 303-421-6111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 1280000012
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License Number State | CO
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