Provider Demographics
NPI:1346312121
Name:DOWNTOWN DRUG INC
Entity Type:Organization
Organization Name:DOWNTOWN DRUG INC
Other - Org Name:DOWNTOWN DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GOTZINGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:970-945-7987
Mailing Address - Street 1:PO BOX 879
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81602-0879
Mailing Address - Country:US
Mailing Address - Phone:970-945-7987
Mailing Address - Fax:970-947-9922
Practice Address - Street 1:825 GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3403
Practice Address - Country:US
Practice Address - Phone:970-945-7987
Practice Address - Fax:970-947-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
COPDO05000000103336C0003X
BD5811369333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21700753Medicaid
2003234OtherPK