Healthcare Provider Details

I. General information

NPI: 1508937517
Provider Name (Legal Business Name): ROCKY MOUNTAIN PHARMACY OF ESTES PARK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 E WONDER VIEW AVE # B1
ESTES PARK CO
80517-9647
US

IV. Provider business mailing address

453 E WONDER VIEW AVE # 1
ESTES PARK CO
80517-9647
US

V. Phone/Fax

Practice location:
  • Phone: 970-586-5577
  • Fax: 970-586-0455
Mailing address:
  • Phone: 970-586-5577
  • Fax: 970-586-0455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPDO.0390000005
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GREG BARTON
Title or Position: PRES
Credential: RPH
Phone: 970-586-1930