Provider Demographics
NPI:1235318544
Name:POWERS INDEPENDENT PHARMACY
Entity Type:Organization
Organization Name:POWERS INDEPENDENT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:OVALLE
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:719-282-8687
Mailing Address - Street 1:8540 SCARBOROUGH DR STE 150
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7533
Mailing Address - Country:US
Mailing Address - Phone:719-282-8687
Mailing Address - Fax:719-282-6085
Practice Address - Street 1:8540 SCARBOROUGH DR STE 150
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7533
Practice Address - Country:US
Practice Address - Phone:719-282-8687
Practice Address - Fax:719-282-6085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
711333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy