MEDICARE: COLORADO PHARMACY LLC

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	615	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306831995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO PHARMACY LLC

Provider Business Mailing Address
First Line	:	PO BOX 300127
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-0127
Country	:	US
Telephone Number	:	303-863-7644
Fax Number	:	303-863-7656

Provider Business Practice Location Address
First Line	:	2490 W 26TH AVE
Second Line	:	SUITE 300A
City	:	DENVER
State	:	CO
Zip	:	80211-5314
Country	:	US
Telephone Number	:	303-458-6200
Fax Number	:	303-458-6203

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JANE NICHOLS
Credential	:
Telephone Number	:	303-863-7644

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	08/22/2020

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Directions to “COLORADO PHARMACY LLC ” Practice Location

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