Provider Demographics
NPI:1992576722
Name:REGENTS OF THE UNIVERSITY OF COLORADO
Entity type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:VERSACKAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MBA
Authorized Official - Phone:303-315-6149
Mailing Address - Street 1:3525 W OXFORD AVE UNIT G-1
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80236-3112
Mailing Address - Country:US
Mailing Address - Phone:303-315-6149
Mailing Address - Fax:
Practice Address - Street 1:5001 S PARKER RD STE 215
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-1183
Practice Address - Country:US
Practice Address - Phone:303-315-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy