| NPI | 1568483519 |
|---|---|
| Doing Business As | IVYWILD PHARMACY |
| Entity Type | Organization |
| Authorized Contact | LAWRENCE BETHEL Owner 719-547-7557 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: CO PDO0240000019) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 333600000X Pharmacy | |
| 3336L0003X Pharmacy Long Term Care Pharmacy | |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2024-02-07 |