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General NPI Number Information
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NPI Number | 1528714979
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Entity Type | Organization
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Legal Business Name | OMNICARE HEALTH SOLUTIONS, INC.
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Dates
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Enumeration Date | 02/24/2022
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 900 INDIANA AVE STE B
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City | PUEBLO
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State | CO
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Zip | 81004-3767
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Country | US
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Telephone | 719-568-8611
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Fax |
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Provider Business Mailing Address
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Address Line | 900 INDIANA AVE STE B
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City | PUEBLO
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State | CO
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Zip | 81004-3767
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Country | US
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Telephone | 719-568-8611
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Fax |
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Authorized Official
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Title or Position | FNP-BC
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Name | NICOLE BOGGS
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Credential |
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Telephone | 719-568-8611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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