Healthcare Provider Details

I. General information

NPI: 1467795674
Provider Name (Legal Business Name): NEAL C HURST PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 E MAIN ST
CORTEZ CO
81321-3307
US

IV. Provider business mailing address

508 E MAIN ST
CORTEZ CO
81321-3307
US

V. Phone/Fax

Practice location:
  • Phone: 970-565-6466
  • Fax: 970-565-2152
Mailing address:
  • Phone: 970-565-6466
  • Fax: 970-565-2152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19240
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: