Provider Demographics
NPI:1700229127
Name:ASSURED PHARMACY DENVER, LLC
Entity Type:Organization
Organization Name:ASSURED PHARMACY DENVER, LLC
Other - Org Name:ASSURED PHARMACY #10
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF STAFF
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-314-0146
Mailing Address - Street 1:12015 E 46TH AVE
Mailing Address - Street 2:STE. 650
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-3116
Mailing Address - Country:US
Mailing Address - Phone:303-749-0490
Mailing Address - Fax:720-536-4826
Practice Address - Street 1:8200 E BELLEVIEW AVE STE 416C
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2807
Practice Address - Country:US
Practice Address - Phone:303-771-3254
Practice Address - Fax:303-771-0547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2244862333600000X
COPDO16800000273336C0003X
WYNR-508203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2139908OtherPK