Provider Demographics
NPI:1669506374
Name:DACONO DRUG
Entity type:Organization
Organization Name:DACONO DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER AND MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:303-833-4016
Mailing Address - Street 1:901 CARBONDALE DR
Mailing Address - Street 2:
Mailing Address - City:DACONO
Mailing Address - State:CO
Mailing Address - Zip Code:80514-9550
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 CARBONDALE DR
Practice Address - Street 2:
Practice Address - City:DACONO
Practice Address - State:CO
Practice Address - Zip Code:80514-9550
Practice Address - Country:US
Practice Address - Phone:303-833-4016
Practice Address - Fax:303-833-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CO14100000013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0610091OtherOTHER ID NUMBER
CO03544400Medicaid
0610091OtherOTHER ID NUMBER-COMMERCIAL NUMBER