Healthcare Provider Details

I. General information

NPI: 1235292145
Provider Name (Legal Business Name): PHARMACA INTEGRATIVE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 SOUTH BOULDER
BOULDER CO
80305
US

IV. Provider business mailing address

4940 PEARL EAST CIRCLE SUITE 301
BOULDER CO
80302-5433
US

V. Phone/Fax

Practice location:
  • Phone: 303-867-3400
  • Fax:
Mailing address:
  • Phone: 303-867-3182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberPDO670
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: GREG LEGORE
Title or Position: DIRECTOR OF PHARMACY OPERATIONS
Credential:
Phone: 805-217-5986