Healthcare Provider Details

I. General information

NPI: 1689157455
Provider Name (Legal Business Name): MARISA DAWN HULSEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISA DAWN ECKSTEIN

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12051 E MISSISSIPPI AVE
AURORA CO
80012-2834
US

IV. Provider business mailing address

916 XAVIER ST
DENVER CO
80204-2833
US

V. Phone/Fax

Practice location:
  • Phone: 303-340-8860
  • Fax:
Mailing address:
  • Phone: 575-313-0365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0022389
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: