Healthcare Provider Details

I. General information

NPI: 1447778667
Provider Name (Legal Business Name): PHILOSTRATOS KLIDARAS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

5765 N GENOA WAY APT 102
AURORA CO
80019-2075
US

V. Phone/Fax

Practice location:
  • Phone: 303-427-9295
  • Fax:
Mailing address:
  • Phone: 720-683-8719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPHA.0020533
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0020533
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: