Provider Demographics
NPI:1952717878
Name:HAXTUN HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:HAXTUN HOSPITAL DISTRICT
Other - Org Name:HAXTUN HOSPITAL DISTRICT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:970-774-6979
Mailing Address - Street 1:235 W FLETCHER ST
Mailing Address - Street 2:
Mailing Address - City:HAXTUN
Mailing Address - State:CO
Mailing Address - Zip Code:80731-2737
Mailing Address - Country:US
Mailing Address - Phone:970-774-6979
Mailing Address - Fax:970-774-7598
Practice Address - Street 1:235 W FLETCHER ST
Practice Address - Street 2:
Practice Address - City:HAXTUN
Practice Address - State:CO
Practice Address - Zip Code:80731-2737
Practice Address - Country:US
Practice Address - Phone:970-774-6979
Practice Address - Fax:970-774-7598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CO16800000653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143360OtherPK