Individual
DAVID MORTENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1311 N MILDRED RD, CORTEZ, CO 81321-2231
(970) 564-2193
(970) 564-2197
Mailing address
1311 N MILDRED RD, CORTEZ, CO 81321-2231
(970) 564-2193
(970) 564-2197
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11995
CO
1835P1200X
Pharmacotherapy Pharmacist
11995
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11995
COLORADO STATE LICENSE
CO
Enumeration date
08/28/2009
Last updated
06/19/2014
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