Provider Demographics
NPI:1558886986
Name:FIALA, URSULA (PHARMD)
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:
Last Name:FIALA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1548
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:CO
Mailing Address - Zip Code:80435-1548
Mailing Address - Country:US
Mailing Address - Phone:970-468-5369
Mailing Address - Fax:
Practice Address - Street 1:300 US HWY 6
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:CO
Practice Address - Zip Code:80435-1548
Practice Address - Country:US
Practice Address - Phone:970-468-5369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0021847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist