Organization
CEDAREDGE PHARMACY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN GEORGE BREITNAUER JR. RPH (OWNER/PHARMACIST)
(970) 856-3161
Entity
Organization
Contact information
Practice address
215 W. MAIN ST, CEDAREDGE, CO 81413
(970) 856-3161
(970) 856-3021
Mailing address
PO BOX 1044, CEDAREDGE, CO 81413-1044
(970) 856-3161
(970) 856-3021
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
20-1
CO
3336C0003X
Community/Retail Pharmacy
Primary
PDOI200000001
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03000494
—
CO
Enumeration date
11/14/2006
Last updated
02/14/2017
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