Provider Demographics
NPI:1699163634
Name:PHARMACA INTEGRATIVE PHARMACY
Entity type:Organization
Organization Name:PHARMACA INTEGRATIVE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-217-5986
Mailing Address - Street 1:4940 PEARL EAST CIR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2489
Mailing Address - Country:US
Mailing Address - Phone:303-867-3182
Mailing Address - Fax:
Practice Address - Street 1:4940 PEARL EAST CIR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2489
Practice Address - Country:US
Practice Address - Phone:505-379-0472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy