Organization
LIROT INC
Active
Other names
Bayfield Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM JERROD CUSICK PHARM D (PRESIDENT, PHARMACIST)
(970) 884-9133
Entity
Organization
Contact information
Practice address
871 COUNTY ROAD 501, BAYFIELD, CO 81122
(970) 884-9133
Mailing address
PO BOX 110, BAYFIELD, CO 81122-0110
(970) 884-9133
(970) 884-0723
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
1420000001
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0611334
NABP
CO
05
—
85182265
—
CO
Enumeration date
11/07/2006
Last updated
10/17/2018
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