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General NPI Number Information
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NPI Number | 1528004173
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Entity Type | Organization
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Legal Business Name | FAMILY PHARMACY
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 08/04/2008
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Provider Practice Location Address
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Address Line | 3150 N 12TH ST
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City | GRAND JUNCTION
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State | CO
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Zip | 81506-2863
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Country | US
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Telephone | 970-256-8465
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Fax | 970-256-8471
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Provider Business Mailing Address
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Address Line | PO BOX 10700
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City | GRAND JUNCTION
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State | CO
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Zip | 81502-5517
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP AND CFO
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Name | MARY BROUGHTON
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Credential |
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Telephone | 970-256-6321
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PDO631
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License Number State | CO
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