Provider Demographics
NPI:1417739129
Name:QUINTANA, LAUREN ALEXIS
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ALEXIS
Last Name:QUINTANA
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 1:6900 S YOSEMITE ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1412
Mailing Address - Country:US
Mailing Address - Phone:303-843-7600
Mailing Address - Fax:
Practice Address - Street 1:3325 28TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1440
Practice Address - Country:US
Practice Address - Phone:303-938-9284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist