Provider Demographics
NPI:1255933024
Name:PASS, BINITA N (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:BINITA
Middle Name:N
Last Name:PASS
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 1:1401 LINDEN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2238
Mailing Address - Country:US
Mailing Address - Phone:847-708-5380
Mailing Address - Fax:
Practice Address - Street 1:2936 COUNCIL TREE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-6300
Practice Address - Country:US
Practice Address - Phone:970-530-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty