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General NPI Number Information
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NPI Number | 1043652654
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Entity Type | Organization
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Legal Business Name | PAGOSA HEALTH
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Dates
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Enumeration Date | 07/24/2013
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Last Update Date | 07/24/2013
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Provider Practice Location Address
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Address Line | 62 DOUGHTY RD STE 4
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City | LAWRENCEBURG
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State | IN
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Zip | 47025-2951
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Country | US
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Telephone | 888-821-9982
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Fax | 800-218-8256
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Provider Business Mailing Address
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Address Line | 62 DOUGHTY RD STE 4
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City | LAWRENCEBURG
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State | IN
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Zip | 47025-2951
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Country | US
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Telephone | 888-821-9982
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Fax | 800-218-8256
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY OPERATION
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Name | RONALD KOEHLER
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Credential |
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Telephone | 859-638-2795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | 60006342A
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License Number State | IN
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