Healthcare Provider Details

I. General information

NPI: 1457945891
Provider Name (Legal Business Name): ELISE NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17761 COTTONWOOD DR
PARKER CO
80134-3925
US

IV. Provider business mailing address

5555 W IDA DR
LITTLETON CO
80123-5134
US

V. Phone/Fax

Practice location:
  • Phone: 303-334-9540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14922
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: