Organization
EASTSIDE EXPRESS PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. IRENE OVALLE MEDINA RPH (MANAGER)
(719) 596-4650
Entity
Organization
Contact information
Practice address
2141 ACADEMY CIR, COLORADO SPRINGS, CO 80909-1686
(719) 596-4650
Mailing address
2141 ACADEMY CIR, COLORADO SPRINGS, CO 80909-1686
(719) 596-4650
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13573
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03003704
—
CO
01
—
0615510
NCPDP
CO
Enumeration date
01/15/2007
Last updated
07/14/2008
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