Provider Demographics
NPI:1144413865
Name:PRIMO ENTERPRISES INC
Entity type:Organization
Organization Name:PRIMO ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:303-822-9371
Mailing Address - Street 1:568 US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:BYERS
Mailing Address - State:CO
Mailing Address - Zip Code:80103-9700
Mailing Address - Country:US
Mailing Address - Phone:303-822-9371
Mailing Address - Fax:303-822-9746
Practice Address - Street 1:568 US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:BYERS
Practice Address - State:CO
Practice Address - Zip Code:80103-9700
Practice Address - Country:US
Practice Address - Phone:303-822-9371
Practice Address - Fax:303-822-9746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1120000001333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03165008Medicaid
CO810096Medicare PIN