Healthcare Provider Details

I. General information

NPI: 1245608710
Provider Name (Legal Business Name): DANIEL GEBREMICHAEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17031 LINCOLN AVE
PARKER CO
80134-3144
US

IV. Provider business mailing address

17031 LINCOLN AVE
PARKER CO
80134-3144
US

V. Phone/Fax

Practice location:
  • Phone: 720-851-7754
  • Fax: 720-851-7767
Mailing address:
  • Phone: 720-851-7754
  • Fax: 720-851-7767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0020957
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: