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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