Basic Information
| Provider Information | |||||||||
| NPI: | 1053357855 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL CENTER OF THE ROCKIES | ||||||||
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| OtherOrganizationName: | UNIVERSITY OF COLORADO SCHOOL OF PHARMACY | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2695 ROCKY MOUNTAIN AVE STE 150 | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805389071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706244443 | ||||||||
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| Practice Location | |||||||||
| Address1: | BOULDER HEALTH CENTER PHARMACY | ||||||||
| Address2: | 5495 ARAPAHOE AVENUE, SUITE 101 | ||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803031224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034992879 | ||||||||
| FaxNumber: | 3034995308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 10/14/2021 | ||||||||
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| AuthorizedOfficialLastName: | EDELBLUT | ||||||||
| AuthorizedOfficialFirstName: | EVA | ||||||||
| AuthorizedOfficialMiddleName: | KATHERINE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR RETAIL PHARMACY SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 9704958036 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0002X | 990000061 | CO | Y | Suppliers | Pharmacy | Clinic Pharmacy |
No ID Information.