1700307055 NPI number — PHARMACA INTEGRATIVE PHARMACY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700307055 NPI number — PHARMACA INTEGRATIVE PHARMACY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMACA INTEGRATIVE PHARMACY, INC.
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:
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:
1700307055
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7088 WINCHESTER CIR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOULDER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80301-3760
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-442-2304
Provider Business Mailing Address Fax Number:
303-867-4181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9101 W OLYMPIC BLVD UNIT A&B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEVERLY HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90212-3507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-277-6266
Provider Business Practice Location Address Fax Number:
310-277-0527
Provider Enumeration Date:
06/27/2017

Additional Information

Authorized Official

Authorized Official Last Name:
FARRELL
Authorized Official First Name:
ALISON
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP PHARMACY SERVICES
Authorized Official Telephone Number:
717-254-9011

Provider Taxonomy Codes

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

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





Copyright © 2007-2025 www.npivalidator.com