Organization
OMNICARE HEALTH SOLUTIONS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE BOGGS (FNP-BC)
(719) 568-8611
Entity
Organization
Contact information
Practice address
900 INDIANA AVE STE B, PUEBLO, CO 81004-3767
(719) 568-8611
Mailing address
900 INDIANA AVE STE B, PUEBLO, CO 81004-3767
(719) 568-8611
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15053065
CAQH PROVIEW
CO
05
—
246844
—
CO
Enumeration date
02/24/2022
Last updated
02/24/2022
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