MEDICARE: KRYSTALIN NICOLE RUSH PHARMD

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	18259	CO

General Provider Information

NPI Number	:	1396027223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTALIN NICOLE RUSH PHARMD

Provider Business Mailing Address
First Line	:	16950 E SMOKY HILL RD
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80015-2482
Country	:	US
Telephone Number	:	303-627-0045
Fax Number	:	303-627-0063

Provider Business Practice Location Address
First Line	:	16950 E SMOKY HILL RD
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80015-2482
Country	:	US
Telephone Number	:	303-627-0045
Fax Number	:	303-627-0063

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

Provider Enumeration Date	:	09/16/2011
Last Update Date	:	09/16/2011

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