Organization
KMART PHRAMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SEYED ABOTALEB ALAVI RPH (PHARMACIST)
(719) 568-0470
Entity
Organization
Contact information
Practice address
3415 N ELIZABETH ST, PUEBLO, CO 81008-1156
(719) 545-0707
(847) 396-2896
Mailing address
206 S GOLFWOOD DR W, PUEBLO, CO 81007-3674
(719) 568-0470
(847) 369-2896
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
0013355
CO
Other
Enumeration date
04/05/2016
Last updated
04/05/2016
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