Healthcare Provider Details

I. General information

NPI: 1114853942
Provider Name (Legal Business Name): RESIAD AHMED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9670 PROMINENT PT
COLORADO SPRINGS CO
80924-5000
US

IV. Provider business mailing address

6455 W HAWTHORN DR APT A
USAF ACADEMY CO
80840-1330
US

V. Phone/Fax

Practice location:
  • Phone: 719-302-4267
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA.0025590
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: