Provider Demographics
NPI:1508060153
Name:RAWHIDE DRUG LLC
Entity Type:Organization
Organization Name:RAWHIDE DRUG LLC
Other - Org Name:RAWHIDE DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:VICKILEE
Authorized Official - Middle Name:KNIGHT
Authorized Official - Last Name:EINHELLIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-461-1975
Mailing Address - Street 1:3780 E 15TH STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538
Mailing Address - Country:US
Mailing Address - Phone:970-461-1975
Mailing Address - Fax:970-461-4042
Practice Address - Street 1:232 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:LUSK
Practice Address - State:WY
Practice Address - Zip Code:82225
Practice Address - Country:US
Practice Address - Phone:307-334-3132
Practice Address - Fax:307-334-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
WYR10029333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies