Provider Demographics
NPI:1124779392
Name:RAWHIDE DRUG LLC
Entity type:Organization
Organization Name:RAWHIDE DRUG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE MGR.
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-481-9668
Mailing Address - Street 1:3780 E 15TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8768
Mailing Address - Country:US
Mailing Address - Phone:970-481-9668
Mailing Address - Fax:
Practice Address - Street 1:232 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LUSK
Practice Address - State:WY
Practice Address - Zip Code:82225-5089
Practice Address - Country:US
Practice Address - Phone:307-334-3132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy