Provider Demographics
NPI:1326483108
Name:TABULA RASA HEALTHCARE GROUP, INC.
Entity Type:Organization
Organization Name:TABULA RASA HEALTHCARE GROUP, INC.
Other - Org Name:CAREKINESIS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ORSULA
Authorized Official - Middle Name:V
Authorized Official - Last Name:KNOWLTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MBA
Authorized Official - Phone:215-680-8983
Mailing Address - Street 1:5303 SPINE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3300
Mailing Address - Country:US
Mailing Address - Phone:888-974-2763
Mailing Address - Fax:303-530-1346
Practice Address - Street 1:5303 SPINE RD STE 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3300
Practice Address - Country:US
Practice Address - Phone:888-974-2763
Practice Address - Fax:303-530-1346
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TABULA RASA HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-07
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22470760Medicaid
2139636OtherPK