NPIMap

Organization Active NPI

Pioneer Pharmacy LLC

  • Long Term Care Pharmacy
  • Wheat Ridge, CO
National Provider Identifier
1912985136
Registry record updated Nov 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
643 Issued in CO
Legal business name
PIONEER PHARMACY LLC
Practice address
3895 Upham St
Ste 60
Wheat Ridge, CO 80033-4651
Phone
(303) 252-7990
Fax
(303) 252-7991
NPI assigned
Jan 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2016

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

Authorized official

Name
Brandon Hagen
Title
Owner
Phone
(303) 525-7990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X 643 CO Primary

Addresses

Primary practice location

3895 Upham St
Ste 60
Wheat Ridge, CO 80033-4651

Mailing address

PO Box 329
Riverton, UT 84065-0329
Phone (303) 252-2990

Other identifiers 2

IdentifierTypeStateIssuer
2003854OtherPK
A5857059MedicaidCO

Other names 1

  • PIONEER PHARMACY LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pioneer Pharmacy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3895 Upham St
Ste 60
Wheat Ridge, CO 80033
Phone (303) 252-7990

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1136505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478217600000",
    "number": "1912985136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 329",
            "city": "RIVERTON",
            "state": "UT",
            "postal_code": "840650329",
            "telephone_number": "303-252-2990",
            "fax_number": "303-252-7991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3895 UPHAM ST",
            "address_2": "STE 60",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800334651",
            "telephone_number": "303-252-7990",
            "fax_number": "303-252-7991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIONEER PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-06",
        "last_updated": "2016-11-04",
        "status": "A",
        "authorized_official_last_name": "HAGEN",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-525-7990"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "CO",
            "license": "643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2003854",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A5857059",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PIONEER PHARMACY LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wheat Ridge, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.