=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386788073
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE APOTHECARY SHOPPE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2007
-----------------------------------------------------
Last Update Date | 02/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 480 MAIN BOX 429
-----------------------------------------------------
City | NUCLA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81424-0429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-864-2100
-----------------------------------------------------
Fax | 970-864-7926
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 429
-----------------------------------------------------
City | NUCLA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81424-0429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-864-2100
-----------------------------------------------------
Fax | 970-864-7926
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. DON ALLAN COLCORD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 970-864-2100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 93-0000002
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------