Organization
CANYON MEDICAL PHARMACY INC
Active
Organization
CANYON MEDICAL PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELVIN MONTANEZ PHARMD (CHIEF OPERATIONS OFFICER)
(407) 830-8820
Entity
Organization
Contact information
Practice address
7265 S REVERE PKWY STE 902, CENTENNIAL, CO 80112-6787
(800) 793-2890
(866) 523-5404
Mailing address
7265 S REVERE PKWY, SUITE 902, CENTENNIAL, CO 80112-6787
(800) 793-2890
(866) 523-5404
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PDO1680000131
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2166868
PK
—
Enumeration date
09/01/2016
Last updated
03/16/2017
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