Healthcare Provider Details

I. General information

NPI: 1376608562
Provider Name (Legal Business Name): KREMMLING MERCANTILE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MARTIN WAY
KREMMLING CO
80459
US

IV. Provider business mailing address

PO BOX 1600
KREMMLING CO
80459-1600
US

V. Phone/Fax

Practice location:
  • Phone: 970-724-3205
  • Fax: 970-724-3225
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number623
License Number StateCO

VIII. Authorized Official

Name: KAREN HAMMER
Title or Position: CONTROLLER
Credential: RPH
Phone: 970-724-3400