Healthcare Provider Details

I. General information

NPI: 1316841638
Provider Name (Legal Business Name): SMITHBURG RETAIL ENTERPRISE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MAIN ST
LIMON CO
80828-5149
US

IV. Provider business mailing address

900 MAIN ST
LIMON CO
80828-5149
US

V. Phone/Fax

Practice location:
  • Phone: 719-775-2371
  • Fax: 719-775-9807
Mailing address:
  • Phone: 719-740-1339
  • Fax: 719-775-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RYAN LEE SMITHBURG
Title or Position: OWNER
Credential: RPH
Phone: 719-775-2371