Provider Demographics
NPI:1306971171
Name:POUDRE DRUG COMPANY
Entity type:Organization
Organization Name:POUDRE DRUG COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:970-484-2777
Mailing Address - Street 1:1221 EAST ELIZABETH
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4066
Mailing Address - Country:US
Mailing Address - Phone:970-484-2777
Mailing Address - Fax:970-407-0449
Practice Address - Street 1:1221 EAST ELIZABETH
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4066
Practice Address - Country:US
Practice Address - Phone:970-484-2777
Practice Address - Fax:970-407-0449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO440000009333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03698842Medicaid