Provider Demographics
NPI:1932455268
Name:REAL WORLD ENTERPRISES, INC
Entity Type:Organization
Organization Name:REAL WORLD ENTERPRISES, INC
Other - Org Name:FOUR SQUARE, PPS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-336-1821
Mailing Address - Street 1:4803 INNOVATION DR
Mailing Address - Street 2:UNIT 2
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-7307
Mailing Address - Country:US
Mailing Address - Phone:970-223-1930
Mailing Address - Fax:
Practice Address - Street 1:4803 INNOVATION DR
Practice Address - Street 2:UNIT 2
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-7307
Practice Address - Country:US
Practice Address - Phone:970-223-1930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPDO-8433336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy