Provider Demographics
NPI:1508937517
Name:ROCKY MOUNTAIN PHARMACY OF ESTES PARK INC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN PHARMACY OF ESTES PARK INC
Other - Org Name:ROCKY MOUNTAIN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:970-586-1930
Mailing Address - Street 1:453 E WONDER VIEW AVE # 1
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-9647
Mailing Address - Country:US
Mailing Address - Phone:970-586-5577
Mailing Address - Fax:970-586-0455
Practice Address - Street 1:455 E WONDER VIEW AVE # B1
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-9647
Practice Address - Country:US
Practice Address - Phone:970-586-5577
Practice Address - Fax:970-586-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
COPDO.03900000053336C0003X
CO3953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03001708Medicaid
2002153OtherPK
121345000Medicare PIN
CO1213450001Medicare NSC