Provider Demographics
NPI:1730771304
Name:IRSIK, AMY MARIE (CPHT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:IRSIK
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:IRSIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPHT
Mailing Address - Street 1:1921 RUTH DR
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-3672
Mailing Address - Country:US
Mailing Address - Phone:303-902-6798
Mailing Address - Fax:
Practice Address - Street 1:4651 W 121ST AVE
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-5662
Practice Address - Country:US
Practice Address - Phone:303-217-9381
Practice Address - Fax:720-887-8438
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000083183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty