Organization
PIONEER PHARMACY LLC
Active
Organization
PIONEER PHARMACY LLC
Active
Other names
Pioneer Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDON HAGEN (DIRECTOR OF OPERATIONS)
(303) 252-7990
Entity
Organization
Contact information
Practice address
1115 ELKTON DR STE 203, COLORADO SPRINGS, CO 80907-3597
(303) 252-7990
(303) 252-7991
Mailing address
PO BOX 329, RIVERTON, UT 84065-0329
(303) 252-7990
(303) 252-7991
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
841
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0622476
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/30/2012
Last updated
06/01/2012
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