MEDICARE: POUDRE DRUG COMPANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	440000009	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306971171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POUDRE DRUG COMPANY

Provider Business Mailing Address
First Line	:	1221 EAST ELIZABETH
Second Line	:	SUITE 1
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4066
Country	:	US
Telephone Number	:	970-484-2777
Fax Number	:	970-407-0449

Provider Business Practice Location Address
First Line	:	1221 EAST ELIZABETH
Second Line	:	SUITE 1
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4066
Country	:	US
Telephone Number	:	970-484-2777
Fax Number	:	970-407-0449

Authorized Official
Title or Position	:	OWNER PHARMACIST
Name	:	MR. ROBERT WALTER REED
Credential	:	RPH
Telephone Number	:	970-484-2777

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/18/2008

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Directions to “POUDRE DRUG COMPANY ” Practice Location

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