George V Drake, RPH
Individual provider Active NPI Pharmacist · Divide, CO
NPI 1508109711 · NPPES record last updated Apr 5, 2013
Key facts
- NPI
- 1508109711
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 10425 (CO)
- Practice address
- 194 Joshua Rd
Divide, CO 80814-9253 - Phone
- (719) 687-1166
- NPI assigned
- Apr 5, 2013
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10425 | CO | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 10425 | CO | Yes |
Addresses
Primary practice location
194 Joshua Rd
Divide, CO 80814-9253
Mailing address
194 Joshua Rd
Divide, CO 80814-9253
Phone (719) 687-1166
Other providers in Divide, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 5, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.