1376000950 NPI number — ARVADA PHARMACY AND MEDICAL SUPPLY

Table of content: (NPI 1376000950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376000950 NPI number — ARVADA PHARMACY AND MEDICAL SUPPLY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARVADA PHARMACY AND MEDICAL SUPPLY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ARVADA PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376000950
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10382 RALSTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARVADA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80004-5860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-707-2444
Provider Business Mailing Address Fax Number:
720-707-2400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10382 RALSTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARVADA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80004-5860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-707-2444
Provider Business Practice Location Address Fax Number:
720-707-2400
Provider Enumeration Date:
03/01/2019

Additional Information

Authorized Official

Authorized Official Last Name:
UKHNOVSKY
Authorized Official First Name:
JULIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
720-707-2444

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20206000260 . This is a "COLORADO STATE DME LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 0626599 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9000171561 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 38356159 . This is a "COLORADO SALEX TAX LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: PDO.1680000194 . This is a "STATE OF COLORADO BOARD OF PHARMACY" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 87071000 . This is a "CITY OF ARVADA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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