Provider Demographics
NPI:1093941494
Name:ABTS PHARMACY LLC
Entity Type:Organization
Organization Name:ABTS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:VICKILEE
Authorized Official - Middle Name:KNIGHT
Authorized Official - Last Name:EINHELLIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-461-1975
Mailing Address - Street 1:3780 E 15TH STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538
Mailing Address - Country:US
Mailing Address - Phone:970-461-1975
Mailing Address - Fax:970-461-4042
Practice Address - Street 1:121 CEDAR STREET
Practice Address - Street 2:
Practice Address - City:JULESBURG
Practice Address - State:CO
Practice Address - Zip Code:80737
Practice Address - Country:US
Practice Address - Phone:970-474-3672
Practice Address - Fax:970-474-3727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-31
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
CO6700000023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO35257377Medicaid
2150536OtherPK
6266560001Medicare NSC
CO35257377Medicaid