Organization
CHINOOK HEALTHCARE INC
Active
Other names
Chinook Healthcare Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TYSON HODGE (PRESIDENT)
(303) 880-2007
Entity
Organization
Contact information
Practice address
275 WANEKA PKWY, STE. 10, LAFAYETTE, CO 80026-8873
(720) 458-4887
(720) 465-9312
Mailing address
275 WANEKA PKWY, STE. 10, LAFAYETTE, CO 80026-8873
(720) 458-4887
(720) 465-9312
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PDO.1680000058
CO
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2146966
PK
—
05
—
54930022
—
CO
Enumeration date
06/25/2014
Last updated
07/19/2018
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