Provider Demographics
NPI:1720143142
Name:MEDICAL BLD PHARMACY INC
Entity Type:Organization
Organization Name:MEDICAL BLD PHARMACY INC
Other - Org Name:ALPINE PROFESSIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:303-444-4448
Mailing Address - Street 1:1000 ALPINE AVE
Mailing Address - Street 2:STE 60
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3406
Mailing Address - Country:US
Mailing Address - Phone:303-444-4448
Mailing Address - Fax:303-444-4449
Practice Address - Street 1:1000 ALPINE AVE
Practice Address - Street 2:STE 60
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3406
Practice Address - Country:US
Practice Address - Phone:303-444-4448
Practice Address - Fax:303-444-4449
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL BLD PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-26
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO90000001333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03036050Medicaid
0607842OtherOTHER ID NUMBER-COMMERCIAL NUMBER