Provider Demographics
NPI:1326465931
Name:COLORADO WEST HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:COLORADO WEST HEALTHCARE SYSTEM
Other - Org Name:CANYON VIEW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF RETAIL PHARMACIES
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:VEJRASKA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MS
Authorized Official - Phone:970-243-3400
Mailing Address - Street 1:2373 G RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-9641
Mailing Address - Country:US
Mailing Address - Phone:970-644-4380
Mailing Address - Fax:970-644-4394
Practice Address - Street 1:2373 G RD
Practice Address - Street 2:SUITE 120
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-9641
Practice Address - Country:US
Practice Address - Phone:970-644-4380
Practice Address - Fax:970-644-4394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16800000553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0623303OtherNCPDP