Organization
BROADWAY PHARMACY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC YOXEY RPH (MANAGER)
(719) 545-0430
Entity
Organization
Contact information
Practice address
101 COLORADO AVE, PUEBLO, CO 81004-4213
(719) 545-0430
(719) 562-8936
Mailing address
101 COLORADO AVE, PUEBLO, CO 81004-4213
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1040000005
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03118007
—
CO
01
—
0605569
OTHER ID NUMBER
—
Enumeration date
02/06/2007
Last updated
08/11/2010
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