Provider Demographics
NPI:1821566712
Name:MERCY PHARMACY LLC
Entity Type:Organization
Organization Name:MERCY PHARMACY LLC
Other - Org Name:MERCY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BICHVAN
Authorized Official - Middle Name:NGUYEN
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:720-232-6735
Mailing Address - Street 1:2200 S FEDERAL BLVD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-5472
Mailing Address - Country:US
Mailing Address - Phone:720-923-6892
Mailing Address - Fax:720-923-6892
Practice Address - Street 1:2200 S FEDERAL BLVD UNIT 3
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-5472
Practice Address - Country:US
Practice Address - Phone:720-923-6892
Practice Address - Fax:720-923-6892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000169442Medicaid