MEDICARE: MR. EUGENE LAMPSON BIGELOW JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	13001	CO

General Provider Information

NPI Number	:	1154996023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EUGENE LAMPSON BIGELOW JR.

Provider Business Mailing Address
First Line	:	2275 GAMBRELL LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3846
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2224 E PIKES PEAK AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-5906
Country	:	US
Telephone Number	:	719-428-2003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2021
Last Update Date	:	06/09/2021

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