Healthcare Provider Details

I. General information

NPI: 1578477691
Provider Name (Legal Business Name): LAURICE FAYE LAFORTEZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURICE FAYE CORPUZ LAFORTEZA

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8959 E DRY CREEK RD
CENTENNIAL CO
80112-2765
US

IV. Provider business mailing address

1450 MORRISON RD UNIT 643
DENVER CO
80204-3258
US

V. Phone/Fax

Practice location:
  • Phone: 720-214-1172
  • Fax:
Mailing address:
  • Phone: 808-450-0348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA.0025749
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: