Provider Demographics
NPI:1235411323
Name:WERTH, JEANNIE UC (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:UC
Last Name:WERTH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4745 ARAPAHOE AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1082
Mailing Address - Country:US
Mailing Address - Phone:720-214-0963
Mailing Address - Fax:720-214-0969
Practice Address - Street 1:4745 ARAPAHOE AVE STE 120
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1082
Practice Address - Country:US
Practice Address - Phone:720-214-0963
Practice Address - Fax:720-214-0969
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16777183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist