Provider Demographics
NPI:1659588069
Name:STADSTAD, AMY E (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:STADSTAD
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 1:6517 S XENON ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-4822
Mailing Address - Country:US
Mailing Address - Phone:303-887-3035
Mailing Address - Fax:303-758-5389
Practice Address - Street 1:2870 S COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6618
Practice Address - Country:US
Practice Address - Phone:303-758-5358
Practice Address - Fax:303-758-5389
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15456183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist