Healthcare Provider Details

I. General information

NPI: 1558111930
Provider Name (Legal Business Name): RUSSELL DEETS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 W 84TH AVE
DENVER CO
80260-4786
US

IV. Provider business mailing address

1575 W 84TH AVE
FEDERAL HEIGHTS CO
80260-4786
US

V. Phone/Fax

Practice location:
  • Phone: 303-427-9176
  • Fax:
Mailing address:
  • Phone: 919-412-6206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number22059
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: