Organization
BONNIE BRAE DRUGSTORE LLC
Active
Other names
Bonnie Brae Drugstore
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN LAGER (OWNER/MANAGER)
(303) 722-7892
Entity
Organization
Contact information
Practice address
2700 E LOUISIANA AVE APT 102, DENVER, CO 80210-2009
(303) 722-7892
(720) 223-7269
Mailing address
2700 E LOUISIANA AVE APT 102, DENVER, CO 80210-2009
(303) 722-7892
(720) 223-7269
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PDO-816
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0622022
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
54301378
—
CO
Enumeration date
02/23/2011
Last updated
02/15/2012
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