1679107486 NPI number — ALTO PHARMACY, LLC

Table of content: (NPI 1679107486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679107486 NPI number — ALTO PHARMACY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALTO PHARMACY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679107486
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 TENNESSEE ST STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94107-3983
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-874-5881
Provider Business Mailing Address Fax Number:
415-484-7058

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1062 DELAWARE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80204-4033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-874-5881
Provider Business Practice Location Address Fax Number:
415-484-7058
Provider Enumeration Date:
03/02/2020

Additional Information

Authorized Official

Authorized Official Last Name:
HAMMOND
Authorized Official First Name:
LAUREN
Authorized Official Middle Name:
Authorized Official Title or Position:
SR. MANAGER OF OPERATIONS
Authorized Official Telephone Number:
800-874-5881

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PDO.1680000207 . This is a "PHARMACY PERMIT" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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