Provider Demographics
NPI:1346554755
Name:QUALMED PHARMACY INC
Entity Type:Organization
Organization Name:QUALMED PHARMACY INC
Other - Org Name:QUALMED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-790-8200
Mailing Address - Street 1:14 INVERNESS DR E
Mailing Address - Street 2:SUITE H-140
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5625
Mailing Address - Country:US
Mailing Address - Phone:303-790-8200
Mailing Address - Fax:
Practice Address - Street 1:14 INVERNESS DR E STE H140
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5646
Practice Address - Country:US
Practice Address - Phone:303-790-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336H0001X
CO8013336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0621804OtherNCPDP PROVIDER IDENTIFICATION NUMBER
6640230001Medicare NSC