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General NPI Number Information
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NPI Number | 1689734592
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Entity Type | Organization
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Legal Business Name | MONUMENT PHARMACY
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 115C SECOND STREET
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City | MONUMENT
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State | CO
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Zip | 80132
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Country | US
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Telephone | 719-481-2209
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 467 115C SECOND STREET
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City | MONUMENT
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State | CO
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Zip | 80132-0467
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Country | US
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Telephone | 719-481-2209
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Fax | 719-481-4971
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Authorized Official
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Title or Position | OWNER
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Name | MR. LEE FRISBIE
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Credential | RPH
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Telephone | 719-481-2209
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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 | 1360000001
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License Number State | CO
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