MEDICARE: REAL WORLD ENTERPRISES, INC

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	3336L0003X	Long Term Care Pharmacy	PDO-843	CO

General Provider Information

NPI Number	:	1932455268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REAL WORLD ENTERPRISES, INC

Provider Business Mailing Address
First Line	:	4803 INNOVATION DR
Second Line	:	UNIT 2
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-7307
Country	:	US
Telephone Number	:	970-223-1930
Fax Number	:

Provider Business Practice Location Address
First Line	:	4803 INNOVATION DR
Second Line	:	UNIT 2
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-7307
Country	:	US
Telephone Number	:	970-223-1930
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICHARD WILSON
Credential	:
Telephone Number	:	858-336-1821

Provider Enumeration Date	:	07/24/2012
Last Update Date	:	02/04/2014

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