Healthcare Provider Details

I. General information

NPI: 1255226643
Provider Name (Legal Business Name): MICHAEL DIAZ PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 SHERIDAN BLVD
EDGEWATER CO
80214-1323
US

IV. Provider business mailing address

2840 BLAKE ST APT 225
DENVER CO
80205-3593
US

V. Phone/Fax

Practice location:
  • Phone: 303-237-6140
  • Fax:
Mailing address:
  • Phone: 818-470-5726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPHA.0025170
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: