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NPI Code Detail

MEDICARE: MARI KATHLEEN PRINCE PHARMD

MEDICARE: MARI KATHLEEN PRINCE PHARMD
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
1183500000XPharmacist21406CO

General Provider Information

NPI Number : 1417401803
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARI KATHLEEN PRINCE PHARMD
Provider Business Mailing Address
First Line : 325 S 5TH ST
Second Line :
City : LA SALLE
State : CO
Zip : 80645-3029
Country : US
Telephone Number : 970-302-6903
Fax Number :
Provider Business Practice Location Address
First Line : 6110 FIRESTONE BLVD
Second Line :
City : FIRESTONE
State : CO
Zip : 80504-6425
Country : US
Telephone Number : 303-682-4160
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2016
Last Update Date : 08/15/2016

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Directions to “ MARI KATHLEEN PRINCE PHARMD” Practice Location

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