Healthcare Provider Details

I. General information

NPI: 1093727083
Provider Name (Legal Business Name): CHOICE CITY DRUG, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 S COLLEGE AVE
FORT COLLINS CO
80524-2808
US

IV. Provider business mailing address

209 N COLLEGE AVE
FORT COLLINS CO
80524-2808
US

V. Phone/Fax

Practice location:
  • Phone: 970-482-1234
  • Fax: 970-482-1098
Mailing address:
  • Phone: 970-482-1234
  • Fax: 970-482-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number440000004
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number440000004
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number440000004
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number440000004
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BERNHARD C WILKINS
Title or Position: CEO
Credential: BSCHEM,BSPHARM,BOC,
Phone: 970-482-1234