Provider Demographics
NPI:1578078192
Name:MORTIMER, CHRISTY K (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:K
Last Name:MORTIMER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S CHEROKEE ST APT S518
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-2151
Mailing Address - Country:US
Mailing Address - Phone:303-808-9855
Mailing Address - Fax:
Practice Address - Street 1:6900 S YOSEMITE ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1418
Practice Address - Country:US
Practice Address - Phone:303-843-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0022039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist