Healthcare Provider Details

I. General information

NPI: 1770064297
Provider Name (Legal Business Name): PRESCRIPTION SHOP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 S PRAIRIE AVE
PUEBLO CO
81005-2253
US

IV. Provider business mailing address

1728 S PRAIRIE AVE
PUEBLO CO
81005-2253
US

V. Phone/Fax

Practice location:
  • Phone: 719-564-0220
  • Fax: 719-564-0424
Mailing address:
  • Phone: 719-564-0220
  • Fax: 719-564-0424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number104-24
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number104-24
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES T SAJBEL
Title or Position: OWNER/PHARMACIST
Credential: PHARMACIST
Phone: 719-564-0220