Active NPI
Brandi Broaddus
- Pharmacist
- Trinidad, CO
National Provider Identifier
1407101470
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 19454
- Practice address
- 457 W Main St
Trinidad, CO 81082-2623 - Phone
- (719) 846-3086
- NPI assigned
- Jul 17, 2012
- Last updated
- Oct 9, 2023
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 19454 | CO | Primary |
Addresses
Primary practice location
457 W Main St
Trinidad, CO 81082-2623
Mailing address
23500 US Highway 160 Ste a
Walsenburg, CO 81089-9524
Phone (719) 738-4500
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19454 | CO | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Huerfano County Hospital District | Current | Accepting new patients | |
| Safeway Inc | Past | Accepting new patients | |
| Safeway Inc | Past | Accepting new patients |
Locations
23500 US Highway 160
Ste A
Walsenburg, CO 81089
Phone (719) 738-4500
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba The Pharmacy at Spanish Peaks
- Community/Retail Pharmacy
- Walsenburg, CO
- NPI 1346983541
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1342483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696809600000",
"number": "1407101470",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23500 US HIGHWAY 160 STE A",
"city": "WALSENBURG",
"state": "CO",
"postal_code": "810899524",
"telephone_number": "719-738-4500",
"fax_number": "719-501-2580"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "457 W MAIN ST",
"city": "TRINIDAD",
"state": "CO",
"postal_code": "810822623",
"telephone_number": "719-846-3086"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROADDUS",
"first_name": "BRANDI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-07-17",
"last_updated": "2023-10-09",
"certification_date": "2023-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CO",
"license": "19454",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Trinidad, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.