Provider Demographics
NPI:1003400078
Name:YOUNG, JESSICA OPORTO (PHARMD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:OPORTO
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8625 E ILIFF AVE UNIT 20
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-3524
Mailing Address - Country:US
Mailing Address - Phone:406-491-5454
Mailing Address - Fax:
Practice Address - Street 1:1240 S PARKER RD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-7558
Practice Address - Country:US
Practice Address - Phone:303-745-3000
Practice Address - Fax:303-745-3202
Is Sole Proprietor?:No
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA0022976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist