Healthcare Provider Details

I. General information

NPI: 1770052961
Provider Name (Legal Business Name): COLORADO RX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 GRANT AVE
LOVELAND CO
80538-8412
US

IV. Provider business mailing address

PO BOX 889
LOVELAND CO
80539-0889
US

V. Phone/Fax

Practice location:
  • Phone: 970-221-9451
  • Fax: 855-535-9359
Mailing address:
  • Phone: 970-221-9451
  • Fax: 855-535-9359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVID FEEBACK
Title or Position: CFO
Credential:
Phone: 970-221-9451