Organization
POUDRE INFUSION THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAUREN N STACKHOUSE (PIC)
(970) 494-2130
Entity
Organization
Contact information
Practice address
915 CENTRE AVE, SUITE 3, FORT COLLINS, CO 80526-6045
(970) 494-2130
(970) 494-2131
Mailing address
915 CENTRE AVE, FORT COLLINS, CO 80526-6045
(970) 494-2130
(970) 494-9815
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
440000021
CO
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
440000021
—
3336H0001X
Home Infusion Therapy Pharmacy
Primary
440000021
CO
3336S0011X
Specialty Pharmacy
440000021
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
90204247
—
CO
Enumeration date
08/10/2005
Last updated
05/18/2026
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