MEDICARE: MRS. ELIZABETH CANNON WILLETT PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PHA.0020333	CO
2	183500000X	Pharmacist	P13021	MS

General Provider Information

NPI Number	:	1174965180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH CANNON WILLETT PHARM.D.

Provider Business Mailing Address
First Line	:	2045 N FRANKLIN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-5437
Country	:	US
Telephone Number	:	303-317-7519
Fax Number	:

Provider Business Practice Location Address
First Line	:	2045 FRANKLIN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-5494
Country	:	US
Telephone Number	:	303-317-7519
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2013
Last Update Date	:	07/08/2021

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