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General NPI Number Information
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NPI Number | 1619059656
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Entity Type | Organization
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Legal Business Name | LEVI PHARMACY INC
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 4020 PALMER PARK BLVD 102C
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-3402
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Country | US
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Telephone | 719-597-7998
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Fax | 719-597-6951
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Provider Business Mailing Address
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Address Line | 4020 PALMER PARK BLVD 102C
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-3402
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Country | US
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Telephone | 719-597-7998
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Fax | 719-597-6951
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Authorized Official
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Title or Position | PRESIDENT PHARMACY MANAGER
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Name | MR. JERRY DAVID LEVI
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Credential | R.PH.
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Telephone | 719-597-7998
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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 | 9538
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License Number State | CO
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