Provider Demographics
NPI:1699441287
Name:PENCOL SPECIALTY PHARMACY LLC
Entity type:Organization
Organization Name:PENCOL SPECIALTY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERREE
Authorized Official - Middle Name:
Authorized Official - Last Name:DISMUKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-388-3613
Mailing Address - Street 1:1325 S. COLORADO BLVD, STE B-024
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222
Mailing Address - Country:US
Mailing Address - Phone:303-388-3613
Mailing Address - Fax:303-388-6182
Practice Address - Street 1:1325 S. COLORADO BLVD, STE B-024
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222
Practice Address - Country:US
Practice Address - Phone:303-388-3613
Practice Address - Fax:303-388-6182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy