Provider Demographics
NPI:1003320573
Name:HURST, ALICIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:
Last Name:HURST
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 E HWY 50
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-2797
Mailing Address - Country:US
Mailing Address - Phone:719-275-1641
Mailing Address - Fax:
Practice Address - Street 1:3105 E HWY 50
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2797
Practice Address - Country:US
Practice Address - Phone:719-275-1641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist