Provider Demographics
NPI:1801466370
Name:DENVER PHARMACY
Entity type:Organization
Organization Name:DENVER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CEO/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESIKA
Authorized Official - Middle Name:S
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-451-3790
Mailing Address - Street 1:3816 NC-16 BUSINESS
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037
Mailing Address - Country:US
Mailing Address - Phone:704-451-5051
Mailing Address - Fax:
Practice Address - Street 1:3816 NC-16 BUSINESS
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037
Practice Address - Country:US
Practice Address - Phone:704-451-5051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1801466370Medicaid