Provider Demographics
NPI:1881903011
Name:UPDEGRAFF, JAMES N
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:N
Last Name:UPDEGRAFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6070 JOHNSON WAY
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-3229
Mailing Address - Country:US
Mailing Address - Phone:303-423-7660
Mailing Address - Fax:
Practice Address - Street 1:403 E MEEKER ST STE 300
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-5904
Practice Address - Country:US
Practice Address - Phone:877-233-0246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO16414183700000X
WAPH0053415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No183700000XPharmacy Service ProvidersPharmacy Technician