Provider Demographics
NPI:1285657528
Name:DENVER HEALTH AND HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:DENVER HEALTH AND HOSPITAL AUTHORITY
Other - Org Name:DENVER HEALTH EASTSIDE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANSAR
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:303-602-7083
Mailing Address - Street 1:501 28TH ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-3003
Mailing Address - Country:US
Mailing Address - Phone:303-602-6519
Mailing Address - Fax:303-436-4099
Practice Address - Street 1:501 28TH ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-3003
Practice Address - Country:US
Practice Address - Phone:303-602-6519
Practice Address - Fax:303-436-4099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9900000033336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03295003Medicaid
2002705OtherPK