Provider Demographics
NPI:1568498426
Name:SENIORX PHARMACY LLC
Entity Type:Organization
Organization Name:SENIORX PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MERRICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHIVELY
Authorized Official - Suffix:
Authorized Official - Credentials:RPHD
Authorized Official - Phone:303-664-0066
Mailing Address - Street 1:500 S ARTHUR AVE
Mailing Address - Street 2:SUITE 300B
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-3065
Mailing Address - Country:US
Mailing Address - Phone:303-664-0066
Mailing Address - Fax:303-664-0099
Practice Address - Street 1:500 S ARTHUR AVE
Practice Address - Street 2:SUITE 300B
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-3065
Practice Address - Country:US
Practice Address - Phone:303-664-0066
Practice Address - Fax:303-664-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6133336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO24783315Medicaid
CO0619520OtherNCPDP