Provider Demographics
NPI:1679909105
Name:XENIA CUSTOM PHARMACY, LLC
Entity Type:Organization
Organization Name:XENIA CUSTOM PHARMACY, LLC
Other - Org Name:XENIA SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:720-669-4567
Mailing Address - Street 1:14001 E ILIFF AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1405
Mailing Address - Country:US
Mailing Address - Phone:720-669-4567
Mailing Address - Fax:303-862-9165
Practice Address - Street 1:14001 E ILIFF AVE STE 200
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1425
Practice Address - Country:US
Practice Address - Phone:720-669-4567
Practice Address - Fax:303-862-9165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16800000403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy