Provider Demographics
NPI:1912738634
Name:LOVELL, JENIKKA MCCALL
Entity type:Individual
Prefix:
First Name:JENIKKA
Middle Name:MCCALL
Last Name:LOVELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7110 W VIRGINIA AVE.
Mailing Address - Street 2:BLDG E #102
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226
Mailing Address - Country:US
Mailing Address - Phone:801-726-2888
Mailing Address - Fax:
Practice Address - Street 1:4401 WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-3302
Practice Address - Country:US
Practice Address - Phone:303-463-7719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0024886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist