Provider Demographics
NPI:1689734592
Name:MONUMENT PHARMACY
Entity Type:Organization
Organization Name:MONUMENT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRISBIE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:719-481-2209
Mailing Address - Street 1:PO BOX 467
Mailing Address - Street 2:115C SECOND STREET
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-0467
Mailing Address - Country:US
Mailing Address - Phone:719-481-2209
Mailing Address - Fax:719-481-4971
Practice Address - Street 1:115C SECOND STREET
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132
Practice Address - Country:US
Practice Address - Phone:719-481-2209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1360000001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty