Provider Demographics
NPI:1548707391
Name:PHARMACA INTEGRATIVE PHARMACY, INC.
Entity type:Organization
Organization Name:PHARMACA INTEGRATIVE PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-217-5986
Mailing Address - Street 1:4940 PEARL EAST CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2489
Mailing Address - Country:US
Mailing Address - Phone:303-867-3182
Mailing Address - Fax:
Practice Address - Street 1:26538 MOULTON PKWY STE G
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-8242
Practice Address - Country:US
Practice Address - Phone:949-900-1605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy