1396145512 NPI number — RACHEL WOODWORTH PHARM D

Table of content: RACHEL WOODWORTH PHARM D (NPI 1396145512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396145512 NPI number — RACHEL WOODWORTH PHARM D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODWORTH
Provider First Name:
RACHEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARM D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396145512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1725 ROCKY MOUNTAIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOVELAND
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80538-8851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-663-1962
Provider Business Mailing Address Fax Number:
970-776-5596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1725 ROCKY MOUNTAIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOVELAND
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80538-8851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-663-1962
Provider Business Practice Location Address Fax Number:
970-776-5596
Provider Enumeration Date:
08/25/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  6199 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 20340 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20340 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 6199 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".