Active NPI
Amy Graves Vander Kooi, PHARM.D
- Pharmacist
- Broomfield, CO
National Provider Identifier
1356618268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 16339
- Practice address
- 570 US Highway 287
Broomfield, CO 80020-1732 - Phone
- (720) 274-0379
- NPI assigned
- Nov 20, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 16339 | CO | Primary |
| Pharmacist | 183500000X | 12107 | TN |
Addresses
Primary practice location
570 US Highway 287
Broomfield, CO 80020-1732
Mailing address
8618 Ellis CT
Arvada, CO 80005-5874
Phone (303) 912-1979
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16339 | CO | MD | Pharmacist |
| 12107 | TN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321747200000",
"number": "1356618268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8618 ELLIS CT",
"city": "ARVADA",
"state": "CO",
"postal_code": "800055874",
"telephone_number": "303-912-1979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "570 US HIGHWAY 287",
"city": "BROOMFIELD",
"state": "CO",
"postal_code": "800201732",
"telephone_number": "720-274-0379"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDER KOOI",
"first_name": "AMY",
"middle_name": "GRAVES",
"credential": "PHARM.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-20",
"last_updated": "2011-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CO",
"license": "16339",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TN",
"license": "12107",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Nov 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.