Healthcare Provider Details

I. General information

NPI: 1447779897
Provider Name (Legal Business Name): LUKE MATTHEW DELZER PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 09/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 BRIARGATE PKWY # 125
COLORADO SPRINGS CO
80920-3480
US

IV. Provider business mailing address

9895 PROMINENT PEAK HTS APT 212
COLORADO SPRINGS CO
80924-8637
US

V. Phone/Fax

Practice location:
  • Phone: 800-218-1059
  • Fax:
Mailing address:
  • Phone: 719-238-8764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0021467
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: