Organization
FAMILY PHARMACY
Active
Organization
FAMILY PHARMACY
Active
Other names
FAMILY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARY BROUGHTON (VP AND CFO)
(970) 256-6321
Entity
Organization
Contact information
Practice address
3150 N 12TH ST, GRAND JUNCTION, CO 81506-2863
(970) 256-8465
(970) 256-8471
Mailing address
PO BOX 10700, GRAND JUNCTION, CO 81502-5517
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PDO631
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0619708
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
49189051
—
CO
Enumeration date
06/21/2006
Last updated
08/04/2008
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