Provider Demographics
NPI:1477172302
Name:PSQUARED MEDICALS, INC
Entity type:Organization
Organization Name:PSQUARED MEDICALS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:OMOLABAKE
Authorized Official - Last Name:SOREMEKUN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:720-583-2110
Mailing Address - Street 1:4809 ARGONNE ST STE 155
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-6834
Mailing Address - Country:US
Mailing Address - Phone:720-583-2110
Mailing Address - Fax:
Practice Address - Street 1:4809 ARGONNE ST STE 155
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-6834
Practice Address - Country:US
Practice Address - Phone:720-583-2110
Practice Address - Fax:720-583-0326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO64330052Medicaid