Provider Demographics
NPI:1376000950
Name:ARVADA PHARMACY AND MEDICAL SUPPLY
Entity Type:Organization
Organization Name:ARVADA PHARMACY AND MEDICAL SUPPLY
Other - Org Name:ARVADA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:UKHNOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT,MS
Authorized Official - Phone:720-707-2444
Mailing Address - Street 1:10382 RALSTON RD
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-5860
Mailing Address - Country:US
Mailing Address - Phone:720-707-2444
Mailing Address - Fax:720-707-2400
Practice Address - Street 1:10382 RALSTON RD
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-5860
Practice Address - Country:US
Practice Address - Phone:720-707-2444
Practice Address - Fax:720-707-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20206000260OtherCOLORADO STATE DME LICENSE
0626599OtherNCPDP
CO9000171561Medicaid
CO38356159OtherCOLORADO SALEX TAX LICENSE
COPDO.1680000194OtherSTATE OF COLORADO BOARD OF PHARMACY
CO87071000OtherCITY OF ARVADA
COFA8238897OtherDEA CERTIFICATE