Provider Demographics
NPI:1669118808
Name:STELLISH, JEREMIAH MICHAEL (RPH)
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:MICHAEL
Last Name:STELLISH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19566 W 56TH DR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-2167
Mailing Address - Country:US
Mailing Address - Phone:303-905-7143
Mailing Address - Fax:
Practice Address - Street 1:3555 N COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-3813
Practice Address - Country:US
Practice Address - Phone:303-320-7847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist