Provider Demographics
NPI:1376690941
Name:NATIONAL JEWISH HEALTH PHARMACY
Entity Type:Organization
Organization Name:NATIONAL JEWISH HEALTH PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL STAFF SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:303-388-4461
Mailing Address - Street 1:1400 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-2761
Mailing Address - Country:US
Mailing Address - Phone:303-388-4461
Mailing Address - Fax:303-270-2174
Practice Address - Street 1:1400 JACKSON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-2762
Practice Address - Country:US
Practice Address - Phone:303-388-4461
Practice Address - Fax:303-270-2174
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL JEWISH HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO144282N00000X, 3336I0012X
3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No282N00000XHospitalsGeneral Acute Care Hospital
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAN0841583OtherDRUG ENFORCEMENT AGENCY
COC060107Medicare PIN
COAN0841583OtherDRUG ENFORCEMENT AGENCY