Healthcare Provider Details

I. General information

NPI: 1417721168
Provider Name (Legal Business Name): SAMUEL ESKENAZI RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 E SOUTH BOULDER RD
LOUISVILLE CO
80027-2344
US

IV. Provider business mailing address

18659 W 84TH DR
ARVADA CO
80007-7224
US

V. Phone/Fax

Practice location:
  • Phone: 303-673-1818
  • Fax: 303-673-1981
Mailing address:
  • Phone: 404-861-6666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0022090
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: