MEDICARE: DR. JUDE PEMBLETON 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	19969	CO
2	183500000X	Pharmacist	60541	CA
3	183500000X	Pharmacist	441824	PA

General Provider Information

NPI Number	:	1508293127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDE PEMBLETON PHARMD

Provider Business Mailing Address
First Line	:	1155 E 9TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-4802
Country	:	US
Telephone Number	:	303-832-5298
Fax Number	:	303-764-3068

Provider Business Practice Location Address
First Line	:	1155 E 9TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-4802
Country	:	US
Telephone Number	:	303-832-5298
Fax Number	:	303-764-3068

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

Provider Enumeration Date	:	09/27/2013
Last Update Date	:	09/27/2013

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