Healthcare Provider Details

I. General information

NPI: 1255422812
Provider Name (Legal Business Name): SAINT VRAIN PHARMACIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 MAIN STREET BOX 949
LYONS CO
80540
US

IV. Provider business mailing address

440 MAIN STREET BOX 949
LYONS CO
80540
US

V. Phone/Fax

Practice location:
  • Phone: 303-823-9134
  • Fax: 303-823-9140
Mailing address:
  • Phone: 303-823-9134
  • Fax: 303-823-9140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1520000001
License Number StateCO

VIII. Authorized Official

Name: MRS. DOLORES A. LOVIN
Title or Position: PRESIDENT
Credential: M.S.,RPH.
Phone: 303-823-9134