Organization
PHARMACA INTEGRATIVE PHARMACY
Active
Organization
PHARMACA INTEGRATIVE PHARMACY
Active
Other names
PHARMACA INTEGRATIVE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL KRUTECK (CFO)
(303) 867-3163
Entity
Organization
Contact information
Practice address
8650 GENESEE AVE, STE 100, SAN DIEGO, CA 92122-1134
(858) 362-5359
Mailing address
4940 PEARL EAST CIR, SUITE 301, BOULDER, CO 80301-2489
(303) 442-2304
(303) 442-4605
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY 49112
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5630834
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/02/2008
Last updated
07/21/2017
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