Healthcare Provider Details

I. General information

NPI: 1053498923
Provider Name (Legal Business Name): PCA VENTURES OF COLORADO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 JOHNSTOWN CENTER DR
JOHNSTOWN CO
80534-9073
US

IV. Provider business mailing address

PO BOX 88
JOHNSTOWN CO
80534-0088
US

V. Phone/Fax

Practice location:
  • Phone: 970-587-1128
  • Fax: 970-587-1139
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number609
License Number StateCO

VIII. Authorized Official

Name: STEVE RAMSEY
Title or Position: PHCY MGR
Credential: RPH
Phone: 970-587-1128