Provider Demographics
NPI:1619047420
Name:WHOLE HEALTH PHARMACY
Entity Type:Organization
Organization Name:WHOLE HEALTH PHARMACY
Other - Org Name:CLEARSPRING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:CARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-940-1689
Mailing Address - Street 1:8550 W 38TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4300
Mailing Address - Country:US
Mailing Address - Phone:303-940-1689
Mailing Address - Fax:
Practice Address - Street 1:201 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4657
Practice Address - Country:US
Practice Address - Phone:303-333-2010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPDO432333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO62801082Medicaid
CO0617235OtherNCPDP
COBC7097466OtherDEA