Provider Demographics
NPI:1699599274
Name:SEMOCK, JOSHUA LAWRENCE
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:LAWRENCE
Last Name:SEMOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3057 N STEELE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-4849
Mailing Address - Country:US
Mailing Address - Phone:847-624-2699
Mailing Address - Fax:
Practice Address - Street 1:4455 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-2415
Practice Address - Country:US
Practice Address - Phone:303-504-7799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COIN.0002009142183500000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No183500000XPharmacy Service ProvidersPharmacist