Healthcare Provider Details

I. General information

NPI: 1942433198
Provider Name (Legal Business Name): BATTLEMENT GROCERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 SIPPRELLE DR
PARACHUTE CO
81635-9232
US

IV. Provider business mailing address

818 S MAIN ST
BLANDING UT
84511-3911
US

V. Phone/Fax

Practice location:
  • Phone: 970-285-5661
  • Fax: 970-285-0149
Mailing address:
  • Phone: 970-925-5295
  • Fax: 970-925-5296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPDO0000000781
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LISA RASMUSSEN
Title or Position: PHARMACY MANAGER
Credential:
Phone: 970-285-5661