Organization
MVPS LLC
Active
Organization
MVPS LLC
Active
Other names
JACKS MARKET PHARMACY, Jack's Market Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW HUTERA (MANAGING MEMBER)
(651) 214-3762
Entity
Organization
Contact information
Practice address
222 SOLAR AVE, MONTE VISTA, CO 81144-1066
(719) 852-9894
(719) 852-9897
Mailing address
903 87TH AVE, HUDSON, WI 54016-7074
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
546
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0618857
OTHER ID NUMBER
—
05
—
06674542
—
CO
Enumeration date
01/22/2007
Last updated
01/28/2022
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