Provider Demographics
NPI:1366842759
Name:PENCOL COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:PENCOL COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:D
Authorized Official - Last Name:TOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:303-388-3613
Mailing Address - Street 1:1325 S COLORADO BLVD
Mailing Address - Street 2:SUITE B-024
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3303
Mailing Address - Country:US
Mailing Address - Phone:303-388-3613
Mailing Address - Fax:
Practice Address - Street 1:1325 S COLORADO BLVD
Practice Address - Street 2:SUITE B-024
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3303
Practice Address - Country:US
Practice Address - Phone:303-388-3613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPDO.16800000683336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy