NPIMap

Organization Active NPI

Pharmaca Integrative Pharmacy, Inc.

  • Community/Retail Pharmacy
  • Boulder, CO
National Provider Identifier
1124187224
Registry record updated Apr 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
670 Issued in CO
Legal business name
PHARMACA INTEGRATIVE PHARMACY, INC.
Practice address
645 S Broadway St
Boulder, CO 80305
Phone
(303) 867-3400
Fax
(303) 867-3411
NPI assigned
Dec 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Alison Farrell
Title
SVP Pharmacy Services
Phone
(717) 254-9011

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 670 CO Primary

Addresses

Primary practice location

645 S Broadway St
Boulder, CO 80305

Mailing address

7088 Winchester Cir Ste 100
Boulder, CO 80301-3760
Phone (303) 442-2304

Other identifiers 2

IdentifierTypeStateIssuer
0620179OtherOTHER ID NUMBER
0620179OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • Medly Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120130000851 CO Part B Supplier - Mass Immunization (Roster Biller Only) 1658550561 Practice locations: Boulder, CO

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

645 S Broadway St
Boulder, CO 80305
Phone (303) 867-3400

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651017600000",
    "number": "1124187224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7088 WINCHESTER CIR STE 100",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803013760",
            "telephone_number": "303-442-2304",
            "fax_number": "303-867-4181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 S BROADWAY ST",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "80305",
            "telephone_number": "303-867-3400",
            "fax_number": "303-867-3411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARMACA INTEGRATIVE PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-27",
        "status": "A",
        "authorized_official_last_name": "FARRELL",
        "authorized_official_first_name": "ALISON",
        "authorized_official_title_or_position": "SVP PHARMACY SERVICES",
        "authorized_official_telephone_number": "717-254-9011"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CO",
            "license": "670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "0620179",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "0620179",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medly Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.