Provider Demographics
NPI:1962662148
Name:R G LORENZO PHARMACY INC
Entity Type:Organization
Organization Name:R G LORENZO PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:LORENZO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:970-526-9417
Mailing Address - Street 1:505 SPRINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-8659
Mailing Address - Country:US
Mailing Address - Phone:970-526-9417
Mailing Address - Fax:970-522-7589
Practice Address - Street 1:505 SPRINGDALE RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-8659
Practice Address - Country:US
Practice Address - Phone:970-526-9417
Practice Address - Fax:970-522-7589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0242420001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0242400001Medicare NSC