Provider Demographics
NPI:1326773375
Name:FRONT RANGE PHARMACY
Entity Type:Organization
Organization Name:FRONT RANGE PHARMACY
Other - Org Name:FRP LONG TERM CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDDIE
Authorized Official - Last Name:SCRUGGS
Authorized Official - Suffix:II
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:864-680-0299
Mailing Address - Street 1:3401 S BROADWAY UNIT 180
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2526
Mailing Address - Country:US
Mailing Address - Phone:720-405-5125
Mailing Address - Fax:720-405-5126
Practice Address - Street 1:3401 S BROADWAY UNIT 180
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2526
Practice Address - Country:US
Practice Address - Phone:720-405-5125
Practice Address - Fax:720-405-5126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-22
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0627060OtherRETAIL PHARMACY NCPDP
1386275527OtherRETAIL PHARMACY NPI
CO9000180774Medicaid