Healthcare Provider Details

I. General information

NPI: 1700968641
Provider Name (Legal Business Name): BONFIGLIO DRUG, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 WEST MAIN STREET
OAK CREEK CO
80467
US

IV. Provider business mailing address

PO BOX 748
OAK CREEK CO
80467-0748
US

V. Phone/Fax

Practice location:
  • Phone: 970-736-2377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number94-01
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number94-01
License Number StateCO

VIII. Authorized Official

Name: DAVID R BONFIGLIO
Title or Position: PRESIDENT
Credential:
Phone: 970-736-2377