Provider Demographics
NPI:1306249024
Name:CENTURA HEALTH PHARMACY AT ST. ANTHONY NORTH
Entity type:Organization
Organization Name:CENTURA HEALTH PHARMACY AT ST. ANTHONY NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:FERLAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MS
Authorized Official - Phone:720-627-0090
Mailing Address - Street 1:14300 ORCHARD PKWY
Mailing Address - Street 2:OUTPATIENT PHARMACY
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80023-9206
Mailing Address - Country:US
Mailing Address - Phone:720-627-0090
Mailing Address - Fax:
Practice Address - Street 1:14300 ORCHARD PKWY
Practice Address - Street 2:OUTPATIENT PHARMACY
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80023-9206
Practice Address - Country:US
Practice Address - Phone:720-627-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPDO.16800000623336S0011X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy