NPIMap

Organization Active NPI

Dillon Companies LLC

Doing business as King Soopers Pharmacy

  • Community/Retail Pharmacy
  • Broomfield, CO
National Provider Identifier
1144463076
Registry record updated Aug 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
764 Issued in CO
Legal business name
DILLON COMPANIES LLC
Doing business as
King Soopers Pharmacy
Practice address
2355 W 136TH Ave
Broomfield, CO 80023
Phone
(303) 920-3050
Fax
(303) 920-3052
NPI assigned
Apr 8, 2009
Last updated
Aug 7, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jessie Warman
Title
Manager of Pharmacy Licensing
Phone
(513) 762-1019

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 764 CO Primary

Addresses

Primary practice location

2355 W 136TH Ave
Broomfield, CO 80023

Mailing address

PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019

Other identifiers 2

IdentifierTypeStateIssuer
52138372MedicaidCO
2119665OtherPK

Other names 1

  • KING SOOPERS PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20081212000377 CO Part B Supplier - Mass Immunization (Roster Biller Only) 5890690135 10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Montrose, CO; Hotchkiss, CO; Fort Collins, CO; Colorado Springs, CO; Broomfield, CO; Alamosa, CO
O20100930007450 CO DME Supplier - Pharmacy 5890690135 Practice locations: Broomfield, CO

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D2098945King Soopers Pharmacy #1182355 W 136TH St, Broomfield, CO 80023Certificate of waiverJul 16, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
King Soopers Pharmacy #1182355 W 136TH Ave, Broomfield, CO 80023-9331(303) 920-3050 Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers|Ostomy Supplies|Urological Supplies|Enteral Nutrients|Enteral Equipment and/or Supplies|Nebulizer Equipment a… Accepts assignmentParticipating since Oct 1, 2007

National Provider Directory

National Provider Directory
Tax ID family
Kroger240 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1239148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533600000000",
    "number": "1144463076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 842772",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022842772",
            "telephone_number": "513-762-1019",
            "fax_number": "513-762-1092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2355 W 136TH AVE",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "80023",
            "telephone_number": "303-920-3050",
            "fax_number": "303-920-3052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DILLON COMPANIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-08",
        "last_updated": "2018-08-07",
        "status": "A",
        "authorized_official_last_name": "WARMAN",
        "authorized_official_first_name": "JESSIE",
        "authorized_official_title_or_position": "MANAGER OF PHARMACY LICENSING",
        "authorized_official_telephone_number": "513-762-1019"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CO",
            "license": "764",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "52138372",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2119665",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KING SOOPERS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "KING SOOPERS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Broomfield, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.