Healthcare Provider Details

I. General information

NPI: 1366877193
Provider Name (Legal Business Name): TEWODROS WUDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

8031 WADSWORTH BLVD
ARVADA CO
80003-1645
US

V. Phone/Fax

Practice location:
  • Phone: 303-427-9295
  • Fax: 303-430-6603
Mailing address:
  • Phone: 303-420-1377
  • Fax: 303-431-5313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19624
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: