Provider Demographics
NPI:1114414604
Name:ORIGIN HEALTHLINK LLC
Entity Type:Organization
Organization Name:ORIGIN HEALTHLINK LLC
Other - Org Name:PARAGON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:UYEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-627-6123
Mailing Address - Street 1:7720 S BROADWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2624
Mailing Address - Country:US
Mailing Address - Phone:720-627-6123
Mailing Address - Fax:720-627-6129
Practice Address - Street 1:7720 S BROADWAY STE 100
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2624
Practice Address - Country:US
Practice Address - Phone:720-627-6123
Practice Address - Fax:720-627-6129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16800001673336C0003X, 3336C0003X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1114414604Medicaid
2177479OtherPK