Provider Demographics
NPI:1306201298
Name:UNCOMPAHGRE COMBINED CLINICS
Entity Type:Organization
Organization Name:UNCOMPAHGRE COMBINED CLINICS
Other - Org Name:UMC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:HARKER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:970-327-4288
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:81423-0280
Mailing Address - Country:US
Mailing Address - Phone:970-327-4233
Mailing Address - Fax:970-327-4228
Practice Address - Street 1:1350 ASPEN STREET
Practice Address - Street 2:SUITE B
Practice Address - City:NORWOOD
Practice Address - State:CO
Practice Address - Zip Code:81423
Practice Address - Country:US
Practice Address - Phone:970-327-4233
Practice Address - Fax:970-327-4228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
CO16800001023336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155192OtherPK