Provider Demographics
NPI:1639423429
Name:HUMPHREY, JOHN D
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:HUMPHREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 S ACADEMY BLVD
Mailing Address - Street 2:SAFEWAY PHARMACY
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-8614
Mailing Address - Country:US
Mailing Address - Phone:719-527-4807
Mailing Address - Fax:
Practice Address - Street 1:6520 S ACADEMY BLVD
Practice Address - Street 2:SAFEWAY PHARMACY
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-8614
Practice Address - Country:US
Practice Address - Phone:719-527-4807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12089183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist