Healthcare Provider Details

I. General information

NPI: 1518042936
Provider Name (Legal Business Name): REAMS PALACE DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MAIN ST
CANON CITY CO
81212-3736
US

IV. Provider business mailing address

PO BOX 159
CANON CITY CO
81212
US

V. Phone/Fax

Practice location:
  • Phone: 719-275-3375
  • Fax: 719-275-4756
Mailing address:
  • Phone: 719-275-3375
  • Fax: 719-275-4756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number170000004
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM SHELVER
Title or Position: CEO
Credential: PHARMD
Phone: 719-275-3375