Organization
HIGH PLAINS COMMUNITY HEALTH CENTER INCORPORATED
Active
Other names
Holly High Plains Dispensary
Organization subpart
No
Provider details
NPI number
Authorized official
JAY BROOKE (PRESIDENT/CEO)
(719) 336-0261
Entity
Organization
Contact information
Practice address
410 WEST COLORADO, HOLLY, CO 81047-0000
(719) 537-6642
Mailing address
410 WEST COLORADO, HOLLY, CO 81047-0000
(719) 537-6642
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
Primary
OO.0000552
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2156199
PK
—
Enumeration date
12/30/2015
Last updated
04/11/2016
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