Provider Demographics
NPI:1588766968
Name:REGENTS OF THE UNIVERSITY OF COLORADO
Entity type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF COLORADO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRIMEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:303-724-0167
Mailing Address - Street 1:13199 EAST MONTVIEW BOULEVARD
Mailing Address - Street 2:#100
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045
Mailing Address - Country:US
Mailing Address - Phone:303-724-0168
Mailing Address - Fax:303-724-0848
Practice Address - Street 1:13199 EAST MONTVIEW BOULEVARD
Practice Address - Street 2:#100
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045
Practice Address - Country:US
Practice Address - Phone:303-724-0168
Practice Address - Fax:303-724-0848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9900000503336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03002862Medicaid
614621OtherNCPDP
CO990000050OtherCOLORADO PHARMACY LICENSE
WY0614621OtherWYOMING PHARMACY LICENSE
WY107812702Medicaid
MT0000211692Medicaid
MT1545OtherMONTANA PHARMACY LICENSE
AZ4115OtherARIZONA PHARMACY LICENSE
NE94OtherNEBRASKA PHARMACY LICENSE
NE94OtherNEBRASKA PHARMACY LICENSE