MEDICARE: PHARMACA INTEGRATIVE PHARMACY INC

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	3336C0003X	Community/Retail Pharmacy	49065	CA
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0500024	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1780682757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACA INTEGRATIVE PHARMACY INC

Provider Business Mailing Address
First Line	:	7088 WINCHESTER CIR STE 100
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-3760
Country	:	US
Telephone Number	:	303-442-2304
Fax Number	:	303-867-4181

Provider Business Practice Location Address
First Line	:	12025 SAN VICENTE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049
Country	:	US
Telephone Number	:	310-476-1237
Fax Number	:	310-476-0152

Authorized Official
Title or Position	:	SVP PHARMACY SERVICES
Name	:	ALISON FARRELL
Credential	:
Telephone Number	:	717-254-9011

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	07/22/2022

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