Healthcare Provider Details

I. General information

NPI: 1801707450
Provider Name (Legal Business Name): SHEHAB AYMN ELHADDAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 S 1ST ST
BENNETT CO
80102-7912
US

IV. Provider business mailing address

1045 S 1ST ST
BENNETT CO
80102-7912
US

V. Phone/Fax

Practice location:
  • Phone: 720-463-6681
  • Fax:
Mailing address:
  • Phone: 720-463-6681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPHA.0025697
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: