Healthcare Provider Details

I. General information

NPI: 1154421493
Provider Name (Legal Business Name): EL PASO COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 E VERMIJO AVE STE 005
COLORADO SPRINGS CO
80903-2208
US

IV. Provider business mailing address

320 S POLK ST STE 100
AMARILLO TX
79101-1436
US

V. Phone/Fax

Practice location:
  • Phone: 719-520-7593
  • Fax: 719-520-7596
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number587
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RHONDA JAQUES
Title or Position: OFFICE CLERK
Credential: AAS
Phone: 806-324-5400