Provider Demographics
NPI:1972789998
Name:ECONO COMP PHARMACY
Entity Type:Organization
Organization Name:ECONO COMP PHARMACY
Other - Org Name:ECONO COMP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FUCHS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:303-817-7665
Mailing Address - Street 1:4760 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2561
Mailing Address - Country:US
Mailing Address - Phone:303-449-1875
Mailing Address - Fax:303-449-4157
Practice Address - Street 1:4760 WALNUT ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2561
Practice Address - Country:US
Practice Address - Phone:303-449-1875
Practice Address - Fax:303-449-4157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0620624OtherNCPDP PROVIDER IDENTIFICATION NUMBER