Provider Demographics
NPI:1053628115
Name:USP BELMAR INC
Entity Type:Organization
Organization Name:USP BELMAR INC
Other - Org Name:UNION SQUARE PHARMACY AT BELMAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:URRUTIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-274-7877
Mailing Address - Street 1:8015 W ALAMEDA AVE STE 100
Mailing Address - Street 2:STE 100
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3075
Mailing Address - Country:US
Mailing Address - Phone:303-274-7877
Mailing Address - Fax:303-274-7974
Practice Address - Street 1:8015 W ALAMEDA AVE STE 100
Practice Address - Street 2:STE 100
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3075
Practice Address - Country:US
Practice Address - Phone:303-274-7877
Practice Address - Fax:303-274-7974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
CO7300000303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4172089Medicaid
2127094OtherPK