Provider Demographics
NPI:1265831291
Name:PLACEK, BARRY (BS IN PHARMACY)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:
Last Name:PLACEK
Suffix:
Gender:M
Credentials:BS IN PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 ORION DR.
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS, CO
Mailing Address - State:CO
Mailing Address - Zip Code:80906-0919
Mailing Address - Country:US
Mailing Address - Phone:402-639-9589
Mailing Address - Fax:
Practice Address - Street 1:1304 CHINOOK LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001
Practice Address - Country:US
Practice Address - Phone:719-296-6937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0020548183500000X
NE10862183500000X
MO044260183500000X
ORRPH-0010379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist