Organization
PEOPLES DRUG STORE
Active
Other names
DENNIS MORTENSEN
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS MORTENSEN (OWNER)
(719) 376-5450
Entity
Organization
Contact information
Practice address
327 MAIN ST, ANTONITO, CO 81120
(719) 376-5450
(719) 376-6362
Mailing address
PO BOX 397, ANTONITO, CO 81120-0397
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
30000002
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03664117
—
CO
01
—
0601573
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
03/06/2007
Last updated
11/29/2007
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