MEDICARE: PRESCRIPTION SHOP LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	335E00000X	Prosthetic/Orthotic Supplier
3	3336C0004X	Compounding Pharmacy
4	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0605735	OTHER		NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972694990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESCRIPTION SHOP LLC

Provider Business Mailing Address
First Line	:	1728 S PRAIRIE AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81005-2253
Country	:	US
Telephone Number	:	719-564-0220
Fax Number	:	719-564-0424

Provider Business Practice Location Address
First Line	:	1728 S PRAIRIE AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81005-2253
Country	:	US
Telephone Number	:	719-564-0220
Fax Number	:	719-564-0424

Authorized Official
Title or Position	:	SENIOR MEMBER
Name	:	JAMES T SAJBEL
Credential	:	RPH
Telephone Number	:	719-564-0220

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	03/19/2026

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Directions to “PRESCRIPTION SHOP LLC ” Practice Location

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