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General NPI Number Information
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NPI Number | 1306971171
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Entity Type | Organization
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Legal Business Name | POUDRE DRUG COMPANY
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 07/18/2008
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Provider Practice Location Address
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Address Line | 1221 EAST ELIZABETH SUITE 1
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City | FORT COLLINS
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State | CO
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Zip | 80524-4066
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Country | US
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Telephone | 970-484-2777
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Fax | 970-407-0449
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Provider Business Mailing Address
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Address Line | 1221 EAST ELIZABETH SUITE 1
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City | FORT COLLINS
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State | CO
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Zip | 80524-4066
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Country | US
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Telephone | 970-484-2777
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Fax | 970-407-0449
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Authorized Official
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Title or Position | OWNER PHARMACIST
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Name | MR. ROBERT WALTER REED
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Credential | RPH
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Telephone | 970-484-2777
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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 | 440000009
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License Number State | CO
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