Healthcare Provider Details

I. General information

NPI: 1609149806
Provider Name (Legal Business Name): TEJVINDER (MISTY) VIRDI RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S HAVANA ST
AURORA CO
80014-1618
US

IV. Provider business mailing address

2500 S HAVANA ST
AURORA CO
80014-1618
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-4434
  • Fax:
Mailing address:
  • Phone: 303-338-4434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15201
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: