Provider Demographics
NPI:1245325836
Name:FOX DRUG, INC
Entity type:Organization
Organization Name:FOX DRUG, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RASHELLE
Authorized Official - Middle Name:V
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-784-3523
Mailing Address - Street 1:1100 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:CO
Mailing Address - Zip Code:81226
Mailing Address - Country:US
Mailing Address - Phone:719-784-3523
Mailing Address - Fax:719-784-6116
Practice Address - Street 1:1100 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:CO
Practice Address - Zip Code:81226
Practice Address - Country:US
Practice Address - Phone:719-784-3523
Practice Address - Fax:719-784-6116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4300000013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03333150Medicaid