Provider Demographics
NPI:1477565703
Name:LISTCO INC
Entity Type:Organization
Organization Name:LISTCO INC
Other - Org Name:SKY RIDGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:ESKANOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-468-0300
Mailing Address - Street 1:10103 RIDGEGATE PKWY
Mailing Address - Street 2:STE 117A
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5520
Mailing Address - Country:US
Mailing Address - Phone:303-468-0300
Mailing Address - Fax:303-468-0307
Practice Address - Street 1:10103 RIDGEGATE PKWY
Practice Address - Street 2:STE 117A
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5520
Practice Address - Country:US
Practice Address - Phone:303-468-0300
Practice Address - Fax:303-468-0307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CO5143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2003524OtherPK
CO61224863Medicaid
2003524OtherPK