=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902652472
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAM J WHITSITT RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2024
-----------------------------------------------------
Last Update Date | 04/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 56929 E 42ND CT
-----------------------------------------------------
City | STRASBURG
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80136-8121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-726-1662
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2530 S PARKER RD
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80014-1623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-613-3292
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P2201X
-----------------------------------------------------
Taxonomy Name | Ambulatory Care Pharmacist
-----------------------------------------------------
License Number | 14199
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------