Provider Demographics
NPI:1801830658
Name:HEALTH TRANS PHARMACY
Entity Type:Organization
Organization Name:HEALTH TRANS PHARMACY
Other - Org Name:HEALTH TRANS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDERNACK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:877-839-8121
Mailing Address - Street 1:8300 E MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4804
Mailing Address - Country:US
Mailing Address - Phone:877-839-8121
Mailing Address - Fax:877-289-0617
Practice Address - Street 1:8300 E MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4804
Practice Address - Country:US
Practice Address - Phone:877-839-8121
Practice Address - Fax:877-289-0617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CO161633336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0619734OtherNCPDP PROVIDER IDENTIFICATION NUMBER