Cedaredge Pharmacy Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PDOI200000001 Issued in CO

Legal business name

CEDAREDGE PHARMACY INC.

Practice address

215 W. Main St
Cedaredge, CO 81413

Phone

(970) 856-3161

Fax

(970) 856-3021

NPI assigned

Nov 14, 2006

Last updated

Feb 14, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. John George Breitnauer Jr., RPHNPI 1003349093

Title

Owner/Pharmacist

Phone

(970) 856-3161

Specialties & licenses 2

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John George Breitnauer Jr., RPH

  • Pharmacist
  • Cedaridge, CO
  • NPI 1003349093
  NPD Authorized official

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487030400000",
    "number": "1194897447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1044",
            "city": "CEDAREDGE",
            "state": "CO",
            "postal_code": "814131044",
            "telephone_number": "970-856-3161",
            "fax_number": "970-856-3021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 W. MAIN ST",
            "city": "CEDAREDGE",
            "state": "CO",
            "postal_code": "81413",
            "telephone_number": "970-856-3161",
            "fax_number": "970-856-3021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAREDGE PHARMACY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2017-02-14",
        "status": "A",
        "authorized_official_last_name": "BREITNAUER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "OWNER/PHARMACIST",
        "authorized_official_telephone_number": "970-856-3161",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CO",
            "license": "20-1",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CO",
            "license": "PDOI200000001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03000494",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Eric Dyer

• Community/Retail Pharmacy in Cedaredge, CO
• Providers in Cedaredge, CO by specialty
• Community/Retail Pharmacy in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.