Provider Demographics
NPI:1801958483
Name:TRX FAMILY PHARMACY, INC.
Entity type:Organization
Organization Name:TRX FAMILY PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:TYREE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:720-565-9900
Mailing Address - Street 1:4745 ARAPAHOE AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1080
Mailing Address - Country:US
Mailing Address - Phone:720-565-9900
Mailing Address - Fax:720-565-9925
Practice Address - Street 1:4745 ARAPAHOE AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1080
Practice Address - Country:US
Practice Address - Phone:720-565-9900
Practice Address - Fax:720-565-9925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO70928321Medicaid
5252930001Medicare ID - Type Unspecified