Provider Demographics
NPI:1992851273
Name:SAYER-MCKEE DRUG STORE
Entity Type:Organization
Organization Name:SAYER-MCKEE DRUG STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:LONGWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-486-1846
Mailing Address - Street 1:615 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:LEADVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80461-3559
Mailing Address - Country:US
Mailing Address - Phone:719-486-1846
Mailing Address - Fax:719-486-0624
Practice Address - Street 1:615 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:LEADVILLE
Practice Address - State:CO
Practice Address - Zip Code:80461-3559
Practice Address - Country:US
Practice Address - Phone:719-486-1846
Practice Address - Fax:719-486-0624
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FFP,LLC DBA SAYER-MCKEE DRUG STORE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-26
Last Update Date:2008-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO770000001333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86325710Medicaid