Provider Demographics
NPI:1538172499
Name:PHARMACY SERVICES INC.
Entity type:Organization
Organization Name:PHARMACY SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-267-3544
Mailing Address - Street 1:228 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ORDWAY
Mailing Address - State:CO
Mailing Address - Zip Code:81063-1403
Mailing Address - Country:US
Mailing Address - Phone:719-267-3544
Mailing Address - Fax:719-267-4443
Practice Address - Street 1:226 MAIN ST
Practice Address - Street 2:
Practice Address - City:ORDWAY
Practice Address - State:CO
Practice Address - Zip Code:81063-1403
Practice Address - Country:US
Practice Address - Phone:719-267-3544
Practice Address - Fax:719-267-4443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0347000003332BP3500X
CO9600000033336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03001625Medicaid
CO960000003OtherSTATE PHARMACY LICENSE
CO03001625Medicaid
CO03001625Medicaid