Basic Information
| Provider Information | |||||||||
| NPI: | 1881903011 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | UPDEGRAFF | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6070 JOHNSON WAY | ||||||||
| Address2: | |||||||||
| City: | ARVADA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800043229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034237660 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 403 E MEEKER ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980305904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8772330246 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2010 | ||||||||
| LastUpdateDate: | 07/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183700000X | CO16414 | CO | N | Pharmacy Service Providers | Pharmacy Technician | 183500000X | PH0053415 | WA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.