Provider Demographics
NPI:1114581428
Name:LINGOW, JONATHAN JAMES
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:JAMES
Last Name:LINGOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SUMMIT BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-8219
Mailing Address - Country:US
Mailing Address - Phone:303-466-7911
Mailing Address - Fax:303-466-7916
Practice Address - Street 1:500 SUMMIT BLVD
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-8219
Practice Address - Country:US
Practice Address - Phone:303-466-7911
Practice Address - Fax:303-466-7916
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0022501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist