Provider Demographics
NPI:1912389222
Name:FRONTIER PHARMACY, LLC
Entity Type:Organization
Organization Name:FRONTIER PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAPHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-726-0808
Mailing Address - Street 1:8941 HARLAN ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-2931
Mailing Address - Country:US
Mailing Address - Phone:303-993-8604
Mailing Address - Fax:844-311-3590
Practice Address - Street 1:8941 HARLAN ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-2931
Practice Address - Country:US
Practice Address - Phone:303-993-8604
Practice Address - Fax:844-311-3590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16800000813336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy