MEDICARE: RALEIGH PROF PHARMACY INC

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	333600000X	Pharmacy	166	CO
2	3336C0003X	Community/Retail Pharmacy
3	3336L0003X	Long Term Care Pharmacy

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
2	0603414	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1649382573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RALEIGH PROF PHARMACY INC

Provider Business Mailing Address
First Line	:	4200 W CONEJOS PL
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-1333
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 W CONEJOS PL
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-1333
Country	:	US
Telephone Number	:	303-573-5601
Fax Number	:	303-893-1039

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TIM WARD
Credential	:
Telephone Number	:	303-573-5601

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/11/2025

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Directions to “RALEIGH PROF PHARMACY INC ” Practice Location

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