Organization
PAGOSA P&C INC.
Active
Other names
Pagosa Specialty Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TOBY LIROT (VICE-PRESIDENT)
(970) 264-4166
Entity
Organization
Contact information
Practice address
426 PAGOSA STREET, PAGOSA SPRINGS, CO 81147
(970) 264-4166
(970) 264-3289
Mailing address
P.O. BOX 120, 426 PAGOSA STREET,, PAGOSA SPRINGS, CO 81147
(970) 264-4166
(970) 264-3289
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PDO.1000000001
CO
3336C0004X
Compounding Pharmacy
PDO.1000000001
CO
3336S0011X
Specialty Pharmacy
PDO.1000000001
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0622779
NCPDP PROVIDER IDENTIFICATION NUMBER
—
01
—
PDO.1000000001
BOARD OF PHARMACY
CO
Enumeration date
11/07/2012
Last updated
12/08/2015
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