| NPI | 1952431694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENNIS MORTENSEN Owner 719-376-5450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy Long Term Care Pharmacy (Licence: CO 30000002) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| 333600000X Pharmacy | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2007-11-29 |