Provider Demographics
NPI:1235292145
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 CIRCLE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5433
Mailing Address - Country:US
Mailing Address - Phone:303-867-3182
Mailing Address - Fax:
Practice Address - Street 1:645 SOUTH BOULDER
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305
Practice Address - Country:US
Practice Address - Phone:303-867-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPDO670302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization