Provider Demographics
NPI:1982987269
Name:JURICH, MARK (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:JURICH
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 W BAPTIST RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-2454
Mailing Address - Country:US
Mailing Address - Phone:719-219-0230
Mailing Address - Fax:719-219-0236
Practice Address - Street 1:725 W BAPTIST RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-2454
Practice Address - Country:US
Practice Address - Phone:719-219-0230
Practice Address - Fax:719-219-0236
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist