Organization
LA JARA PHARMACEUTICAL CENTER, INC.
Active
Organization
LA JARA PHARMACEUTICAL CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH THOMAS VALDEZ RPH (PHARMACIST OWNER)
(719) 274-5109
Entity
Organization
Contact information
Practice address
412 MAIN STREET, LA JARA, CO 81140
(719) 274-5109
(719) 274-4246
Mailing address
412 MAIN ST, PO BOX 609, LA JARA, CO 81140
(719) 274-5109
(719) 274-4246
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
AL7908114
CO
3336C0003X
Community/Retail Pharmacy
Primary
AL7908114
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03498474
—
CO
01
—
1346336997
MEDICARE NPI
CO
Enumeration date
10/04/2006
Last updated
04/17/2017
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