=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053332007
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BGS PHARMACY PARTNERS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2006
-----------------------------------------------------
Last Update Date | 04/05/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4465 NORTHPARK DR STE #303
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-471-7810
-----------------------------------------------------
Fax | 719-471-7804
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4465 NORTHPARK DR STE #303
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-471-7810
-----------------------------------------------------
Fax | 719-471-7804
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY MANAGER
-----------------------------------------------------
Name | EILENE RIEBER
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 719-741-7810
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336H0001X
-----------------------------------------------------
Taxonomy Name | Home Infusion Therapy Pharmacy
-----------------------------------------------------
License Number | 240000124
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0004X
-----------------------------------------------------
Taxonomy Name | Compounding Pharmacy
-----------------------------------------------------
License Number | 240000124
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | 240000124
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------