Provider Demographics
NPI:1144410382
Name:PHARMACA INTEGRATIVE PHARMACY
Entity Type:Organization
Organization Name:PHARMACA INTEGRATIVE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUTECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-867-3163
Mailing Address - Street 1:7088 WINCHESTER CIR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3760
Mailing Address - Country:US
Mailing Address - Phone:303-442-2304
Mailing Address - Fax:303-867-4180
Practice Address - Street 1:4139 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2645
Practice Address - Country:US
Practice Address - Phone:949-823-9762
Practice Address - Fax:949-823-9763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA486393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5627661OtherOTHER ID NUMBER