Organization Name: | VAIL CLINIC, INC |
NPI Number: | 1225017643 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SURESH BOODRAM (PHARM MGN) |
Mailing Address: | 322 Beard Creek Rd Edwards |
State: | CO US |
Postal Code: | 816326426 |
Phone Number: | 9705697676 |
Fax Number: | 9705697677 |
NPI Enumeration Date: | 01/13/2006 |
NPI Last Update Date: | 02/03/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 3336C0002X |
License Number: | 1470000002 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Pharmacy |
Taxonomy Specialization: | Clinic Pharmacy |
Taxonomy Definition: | A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. |