Provider Demographics
NPI:1114512084
Name:ESCOBAR, HEIDI ANNA (PHARMD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:ANNA
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 HOMESTEAD DR APT 20
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-8160
Mailing Address - Country:US
Mailing Address - Phone:970-390-6519
Mailing Address - Fax:
Practice Address - Street 1:435 EDWARDS ACCESS RD
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-5633
Practice Address - Country:US
Practice Address - Phone:970-855-7379
Practice Address - Fax:970-477-5167
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00210171835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1154717981Medicaid