Provider Demographics
NPI:1487918561
Name:HEARTLAND PHARMACY - DENVER
Entity type:Organization
Organization Name:HEARTLAND PHARMACY - DENVER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECITIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-497-3575
Mailing Address - Street 1:1790 SABIN DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-6747
Mailing Address - Country:US
Mailing Address - Phone:208-552-7677
Mailing Address - Fax:208-552-2103
Practice Address - Street 1:8599 PRAIRIE TRAIL DR
Practice Address - Street 2:STE A300
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-7100
Practice Address - Country:US
Practice Address - Phone:208-552-7677
Practice Address - Fax:208-552-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO333600000X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy