| NPI | 1265034573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GUADALUPE FLORES Sr Provider Enrollment COO Rd 303-338-3382 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336M0003X Pharmacy Managed Care Organization Pharmacy |
| Enumeration Date | 2020-11-11 |
| Last Update Date | 2021-05-23 |