Healthcare Provider Details

I. General information

NPI: 1730818006
Provider Name (Legal Business Name): EHIABHI KINGSLEY EHIZUELEN PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DR. KINGSLEY EHIABHI EHIZUELEN

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16290 E QUINCY AVE
AURORA CO
80015-1594
US

IV. Provider business mailing address

6758 S CATAWBA WAY
AURORA CO
80016-5943
US

V. Phone/Fax

Practice location:
  • Phone: 303-699-3820
  • Fax:
Mailing address:
  • Phone: 720-545-7470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number17163
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: