Provider Demographics
NPI:1831249580
Name:KEBD ENTERPRISES, LLC
Entity type:Organization
Organization Name:KEBD ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-763-5533
Mailing Address - Street 1:12860 W CEDAR DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1975
Mailing Address - Country:US
Mailing Address - Phone:303-763-5533
Mailing Address - Fax:303-763-5552
Practice Address - Street 1:12860 W CEDAR DR
Practice Address - Street 2:SUITE 210
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1975
Practice Address - Country:US
Practice Address - Phone:303-763-5533
Practice Address - Fax:303-763-5552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO73-183336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0604923OtherNABP