Healthcare Provider Details

I. General information

NPI: 1285106765
Provider Name (Legal Business Name): PHLOURISH RX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 BRENNER PL
COLORADO SPRINGS CO
80917-5810
US

IV. Provider business mailing address

3305 BRENNER PL
COLORADO SPRINGS CO
80917-5810
US

V. Phone/Fax

Practice location:
  • Phone: 785-766-8149
  • Fax:
Mailing address:
  • Phone: 785-766-8149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VIXEN DEINES
Title or Position: OWNER
Credential: PHARMD
Phone: 785-766-8149