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General NPI Number Information
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NPI Number | 1669889739
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Entity Type | Organization
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Legal Business Name | ATLAS LIQUOR, LLC
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Dates
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Enumeration Date | 07/21/2014
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Last Update Date | 07/21/2014
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Provider Practice Location Address
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Address Line | 2770 ARAPAHOE RD
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City | LAFAYETTE
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State | CO
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Zip | 80026-8018
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Country | US
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Telephone | 720-287-1728
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Fax |
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Provider Business Mailing Address
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Address Line | 3939 95TH ST
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City | BOULDER
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State | CO
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Zip | 80301-4942
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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 | OWNER
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Name | MR. JOHN COHAGEN
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Credential |
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Telephone | 303-661-0822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 1680000059
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License Number State | CO
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