Healthcare Provider Details

I. General information

NPI: 1821291410
Provider Name (Legal Business Name): KARL RAY FOREMAN RPH PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX V 330 MOUNTAIN AVE
BERTHOUD CO
80513-0620
US

IV. Provider business mailing address

2591 FRANCES DR
LOVELAND CO
80537-6967
US

V. Phone/Fax

Practice location:
  • Phone: 970-532-2034
  • Fax: 970-532-4799
Mailing address:
  • Phone: 970-622-8271
  • Fax: 970-532-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15776
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: