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General NPI Number Information
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NPI Number | 1538238464
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Entity Type | Organization
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Legal Business Name | LIROT INC
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 10/17/2018
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Provider Practice Location Address
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Address Line | 871 COUNTY ROAD 501
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City | BAYFIELD
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State | CO
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Zip | 81122
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Country | US
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Telephone | 970-884-9133
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 110
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City | BAYFIELD
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State | CO
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Zip | 81122-0110
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Country | US
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Telephone | 970-884-9133
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Fax | 970-884-0723
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Authorized Official
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Title or Position | PRESIDENT, PHARMACIST
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Name | DR. WILLIAM JERROD CUSICK
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Credential | PHARM D
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Telephone | 970-884-9133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 1420000001
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License Number State | CO
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