Peoples Drug Store

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

30000002 Issued in CO

Legal business name

PEOPLES DRUG STORE

Doing business as

Dennis Mortensen

Practice address

327 Main St
Antonito, CO 81120

Phone

(719) 376-5450

Fax

(719) 376-6362

NPI assigned

Mar 6, 2007

Last updated

Nov 29, 2007By 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

Dennis Mortensen

Title

Owner

Phone

(719) 376-5450

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• DENNIS MORTENSEN Doing business as

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.

• Bryan Andre Sandoval, RPH.

  • Pharmacist
  • Antonito, CO
  • NPI 1447401963
  NPD (past)

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196294400000",
    "number": "1952431694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 397",
            "city": "ANTONITO",
            "state": "CO",
            "postal_code": "811200397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "327 MAIN ST",
            "city": "ANTONITO",
            "state": "CO",
            "postal_code": "81120",
            "telephone_number": "719-376-5450",
            "fax_number": "719-376-6362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEOPLES DRUG STORE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2007-11-29",
        "status": "A",
        "authorized_official_last_name": "MORTENSEN",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-376-5450"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "CO",
            "license": "30000002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "0601573",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "0601573",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03664117",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DENNIS MORTENSEN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Darrick J Garcia
• Thomas Gonzales
• Lutheran Hospital Association of the San Luis Valley (SLV Health Antonito Clinic)
• Ted L Morrison, PAC
• Optimal Home Health Care LLC
• Tabitha Molly Polley, RN
• San Luis Valley Community Mental Health Center (San Luis Valley Behavioral Health Group)
• San Luis Valley Community Mental Health Center (San Luis Valley Behavioral Health Group)
• San Luis Valley Community Mental Health Center (San Luis Valley Behavioral Health Group)
• San Luis Valley Community Mental Health Center, Inc. (San Luis Valley Behavioral Health Group)

• Long Term Care Pharmacy in Antonito, CO
• Providers in Antonito, CO by specialty
• Long Term Care Pharmacy in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.