Provider Demographics
NPI:1356684575
Name:LUPO, ALEXA N
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:N
Last Name:LUPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 QUENTIN ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7125
Mailing Address - Country:US
Mailing Address - Phone:720-857-6422
Mailing Address - Fax:303-857-6509
Practice Address - Street 1:1919 QUENTIN ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7125
Practice Address - Country:US
Practice Address - Phone:720-857-6422
Practice Address - Fax:720-857-6509
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist