Most Relevant Information
Provider Data
| NPI Number: | 1003442534 |
| Provider Name: | JOHN CHARLES THEISEN PHARMD |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | 22863 |
Most Important Dates
| Enumeration Date: | 03/16/2020 |
| Last Updated: | 03/16/2020 |
Provider Practice Location
3143 W COLORADO AVE
COLORADO SPRINGS
CO
809042040
Practice Location Phone/Fax
| Phone: | 7196327112 |
| Fax: |
Provider Mailing Location
727 W 7TH AVE
FORT MORGAN
CO
807012809
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |