Provider Demographics
NPI:1174600209
Name:HALDUN INC A COLORADO CORPORATION
Entity type:Organization
Organization Name:HALDUN INC A COLORADO CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSENGILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-421-6111
Mailing Address - Street 1:6650 W 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4906
Mailing Address - Country:US
Mailing Address - Phone:303-421-6111
Mailing Address - Fax:
Practice Address - Street 1:6650 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4906
Practice Address - Country:US
Practice Address - Phone:303-421-6111
Practice Address - Fax:303-431-8320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
CO12800000123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135198OtherPK