Provider Demographics
NPI:1598325573
Name:FOSSUM, CARA ALEXANDRA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CARA
Middle Name:ALEXANDRA
Last Name:FOSSUM
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 STRAUSS CABIN RD.
Mailing Address - Street 2:12-212
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528
Mailing Address - Country:US
Mailing Address - Phone:703-297-6903
Mailing Address - Fax:
Practice Address - Street 1:201 JOHNSTOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-9005
Practice Address - Country:US
Practice Address - Phone:970-587-1128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00228611835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist