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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