Provider Demographics
NPI:1578666327
Name:WINDSOR GARDENS DRUG
Entity Type:Organization
Organization Name:WINDSOR GARDENS DRUG
Other - Org Name:COLORADO APOTHECARY, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLEGOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:303-364-9318
Mailing Address - Street 1:9660 E. ALAMEDA AVENUE
Mailing Address - Street 2:#110
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1290
Mailing Address - Country:US
Mailing Address - Phone:303-364-9318
Mailing Address - Fax:303-364-9310
Practice Address - Street 1:9660 E. ALAMEDA AVENUE
Practice Address - Street 2:#110
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-1290
Practice Address - Country:US
Practice Address - Phone:303-364-9318
Practice Address - Fax:303-364-9310
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINDSOR GARDENS DRUG
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-07
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00724831Medicaid