Provider Demographics
NPI:1235150285
Name:PHARMACA INTEGRATIVE PHARMACY, INC.
Entity Type:Organization
Organization Name:PHARMACA INTEGRATIVE PHARMACY, INC.
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:805-217-9926
Mailing Address - Street 1:4940 PEARL EAST CIRCLE
Mailing Address - Street 2:SUITE 301
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 1:1647 PEARL STREET
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302
Practice Address - Country:US
Practice Address - Phone:303-442-5164
Practice Address - Fax:303-939-9388
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMACA INTEGRATIVE PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-22
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO900000043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0601787OtherOTHER ID NUMBER
CO58322272Medicaid
CO58-322272Medicaid
0601787OtherOTHER ID NUMBER-COMMERCIAL NUMBER