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General NPI Number Information
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NPI Number | 1710097969
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Entity Type | Organization
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Legal Business Name | MESA PHARMACY OF PUEBLO, INC.
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 12/13/2007
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Provider Practice Location Address
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Address Line | 25140 E US HIGHWAY 50
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City | PUEBLO
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State | CO
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Zip | 81006-9737
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Country | US
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Telephone | 719-544-1371
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Fax | 719-546-1961
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Provider Business Mailing Address
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Address Line | 25140 E US HIGHWAY 50
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City | PUEBLO
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State | CO
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Zip | 81006-9737
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Country | US
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Telephone | 719-544-1371
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Fax | 719-546-1961
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MARGARET A FRANTZ
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Credential | RPH
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Telephone | 719-544-1371
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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 | 10429
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License Number State | CO
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