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General NPI Number Information
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NPI Number | 1326465931
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Entity Type | Organization
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Legal Business Name | COLORADO WEST HEALTHCARE SYSTEM
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Dates
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Enumeration Date | 03/20/2014
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Last Update Date | 05/07/2014
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Provider Practice Location Address
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Address Line | 2373 G RD SUITE 120
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City | GRAND JUNCTION
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State | CO
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Zip | 81505-9641
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Country | US
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Telephone | 970-644-4380
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Fax | 970-644-4394
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Provider Business Mailing Address
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Address Line | 2373 G RD SUITE 120
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City | GRAND JUNCTION
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State | CO
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Zip | 81505-9641
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Country | US
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Telephone | 970-644-4380
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Fax | 970-644-4394
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Authorized Official
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Title or Position | DIRECTOR OF RETAIL PHARMACIES
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Name | MARK THOMAS VEJRASKA
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Credential | PHARM.D., M.S.
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Telephone | 970-243-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 1680000055
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License Number State | CO
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